Introduction to the case
Summer is the period of fractured incisors in pediatric patients! I am doing this kind of work every week!
25 years ago I started restoring these fractured cusps this way and have only lost a couple of the 20-30 plus teeth I have restored this way. Conventional treatment has been extraction in many cases. Some have had previous RCT.
I percolate Javex or bleach (same stuff I use for RC) into the fracture to clean any organic crap out and help just clean the fracture line. Then I wash profusely for 20 seconds to get rid of the bleach. Then dry and etch moving the piece open and close to suck and pump the etch down the crack. Then wash for 3 seconds and since I am using a 4th generation bonding system I place 5-6 coats of primer on the tooth and use a little more than usual to get the primer down the crack. This will take me close to 60 seconds to place these coats of primer and let it evaporate for several seconds between coats. I will sometimes write up my chart while I wait for the primer to evaporate but I know I will get a hybrid layer and good bonding results this way. Then I dry for 5 seconds and liberally apply my bonding resin and push the piece together and cure with my Valo for 20 seconds. My resin is dual cure so it cures well. The tooth is sealed and should function just fine as have the other couple of dozen I have restored this way. Some were restored this way 25 year ago and still working!
Pt. presented w/ #8 class 3 mobility, horizontal fx. below crest of bone. Treatment included exo, immediate placement w/ graft, provisional using existing tooth screw retained out of occlusion.