Case Study 1: Managing a Fractured Premolar with Crown Restoration

Patient Problem

A female patient came in looking normal, with no facial swelling or TMJ tenderness. When clinically checked, we witnessed a mild sensitivity in the patient’s upper left premolar (tooth #14) after chipping a previously restored tooth. The old composite restoration was also lost, but the patient did not experience pain on percussion.

The patient also has good oral hygiene overall and did not have signs of gum disease.

Proposed Diagnosis & Treatment Plan

Tooth #14 was structurally compromised due to the fracture and the breakdown of the old restoration. However, the pulp is still vital. Based on the clinical and radiographic findings, a conservative approach was recommended to restore both function and aesthetics.

Here are the steps recommended for the patient’s treatment plan:

1. Removal of the old, failing restoration and any associated caries.
2. Placement of a bonded composite resin core to build up and strengthen the tooth.
3. Preparation of the tooth for a full-coverage zirconia crown.
4. Placement of a temporary provisional crown to protect the tooth while the final crown is being fabricated.
5. Final cementation of the laboratory-fabricated zirconia crown.
6. Reinforcement of oral hygiene instructions and scheduling of follow-up appointments.

Treatment Procedure

Appointment 1:

After local anaesthesia, the tooth was cleaned, where all carious tissue and old restorative material were carefully removed. A composite resin core was placed in the tooth to provide a solid foundation. The tooth was then prepared with the precise dimensions required for a zirconia crown, which will be placed after a few weeks.

A final impression was taken using PVS material, and a temporary crown was fabricated to ensure tooth protection while waiting for the permanent crown to be ready.

Appointment 2 (2 weeks later):

The temporary crown was removed, and the underlying tooth was cleaned. The fit, margins, shade, and occlusion of the final zirconia crown were meticulously verified and adjusted. Once confirmed, the crown was permanently cemented into place.

Outcome and Follow-Up

The patient was monitored to ensure the long-term success of the restoration.

• 7-Day Follow-Up: A post-operative check confirmed the crown was functioning well on the patient. The margins were well-adapted, and the previously reported sensitivity had resolved.
• 6-Month Follow-Up: The clinical examination showed the zirconia crown maintained excellent aesthetics and function. There were no signs of recurrent decay or any periodontal issues associated with the restoration. The clinical outcome was deemed successful and stable.

Clinical Discussion

This case presents a conservative and effective restorative approach for a structurally compromised vital premolar (tooth #14). Since the patient still has enough tooth structure to hold a crown, a full-coverage crown was the treatment of choice to provide long-term protection against occlusal forces. Zirconia was also selected for its high strength and excellent aesthetic properties, making it an ideal material for the premolar region.

The successful outcome highlights the importance of proper case selection, meticulous tooth preparation, and precise cementation techniques for the longevity of crown restorations.

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