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The interface between dental restorations and the neighbouring soft tissue is of key significance for restorative success and longevity. Trauma-related enamel–dentine fractures are frequently present with the restorative challenge of subgingival margins and little remaining tooth structure. This report looks at two paediatric dental trauma patients with extensive crown fractures resulting in subgingival margins, which posed a poor long-term tooth survival. Electrosurgery was used before definitive composite restorations to allow for supragingival margins and access. Each patient attended the Child Dental Health Department at the University of Manchester Dental Hospital for assessment and treatment provision.
CPD/Clinical Relevance: This article identifies electrosurgery as an increasingly useful adjunct to restorative management of traumatized permanent incisor teeth in paediatric patients.
Article
The long-lasting restorative success of composite restorations is based upon a multitude of factors. Principal reasons for failure include secondary caries, wear, fracture and marginal deficiency causing leakage.1 The position of the gingival margin around the intended restoration can influence the likelihood of any of these factors.2 A good restorative and cosmetic outcome can be achieved when tissues surrounding the teeth are healthy and stable.3 Gingival hyperplasia can be an adverse effect of dental trauma, especially if the tooth has an accompanying cervical fracture that extends towards the gingival periphery.3
The latest Child Dental Health Survey carried out in 2013 suggested that around one in 10 children between the ages of 12 and 15 years had sustained dental trauma to their incisor teeth.4 Notably, the permanent teeth most affected by trauma were the upper central incisors. Crown fractures are the most prominent type of dental injury, accounting for 26–76% of dental trauma injuries.4,5,6 Less than 7% of crown fractures involve the root.7 The more coronal the fracture line, the better the chance of a favourable outcome. Subgingival fractures often provide insufficient crown height and pose a restorative dilemma for the dental practitioner.7
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