Re-intervention on a restored fractured central incisor after one year of restoration replacement: from direct to indirect approach

Traumatic dental injuries are common cases reported in Dentistry and may result in damage of hard dental tissues, pulpal complex, and periradicular structures. The anterior tooth, involving enamel and dentin, is the most frequent tooth affected, in which the coral fractures represents 65-75% of all dental traumas.1‒3 According to a review, for the permanent dentition the crown fractures without pulp exposure is the most common injury described in most studies.4 Also, the maxillary central incisor is the most frequently affect teeth.4,5 One of the post-traumatic complications, with and without pulp exposure, is the tooth discoloration caused by intrapulpal hemorrhage, in which the bloody degradation byproducts (such as hemosiderin, hemine, hematin and hematoidin) penetrates into the dentinal tubules staining the dentin structure.6,7 Yellow discoloration can also be correlated to pulp obliteration, another dental trauma sequel.6 The darker color, in these cases, is related to the decrease in translucence due to a greater thickness of dentin that were deposited as a response to the trauma.8,9 In cases where no pulp necrosis or signs of infection is detected, by radiographic evaluation, clinical examination and clinical signs and symptoms, the recommendation is to follow the patient without any endodontic intervention.8