Fabricating a Single Anterior Tooth for a 9-Year-Old Boy

By Alexander Wünsche, CDT, ZT

Restorative Challenge

Milo was nine years old when he fractured his right maxilla incisor flat to the gingiva while playing sports (see Figure 1 below). His mother immediately brought him to his dentist, Dr. Ricardo Castaneda in Miami, FL.

After clinical evaluation, it was clear the tooth could not be saved and the dental team had to consider a restorative solution; they decided to do a root canal on the incisor (see Figures 2-3 below) and extrude the tooth with orthodontic treatment (see Figure 4 below). This was very successful in terms of gained tooth volume and Dr. Castaneda was able to prepare the tooth for a future crown; however, after preparation, the stump turned very dark, very quickly (see Figure 5 below).

The case was presented to me 10 months after Milo’s injury and the patient and his family were understandably frustrated; Dr. Castaneda had tried three other laboratories...