The Biomimetic Dentistry Approach to treating #9 Trauma

This was a unique situation I treated over 2 years ago with great success. The patient came to me for a second opinion after hearing about Biomimetic Dentistry from her mother. She had fallen and #9 was fractured completely, with only the lingual connective tissue attachment holding the fragment in place.

Biomimetic Dentistry and Trauma Fracture

The patient had already seen another dentist for a consult and was provided with the traditional treatment options including: bridge, implant, or a removable partial. She came to hoping to save her tooth which she was told was not savable.
After reviewing the case, my feeling was that this tooth could be restored for an interim duration. I reviewed that all treatment options, including implant, will have complications over a long period of time. I recommended eventual implant placement, but only after maintaining her tooth for as long as possible without bone loss, recession, or discomfort.

Step By Step Biomimetic Approach

#1-Trauma- Biomimetic Dentistry Approach

Fracture Extends into pulp and the lingual gingival connective tissue attachment is holding the fragment in place loosely.

#2 -Trauma Biomimetic Dentistry Approach

Shade Selected to stabilize tooth with facial and proximal adhesive bonding prior to endodontic therapy

#3 -Trauma Biomimetic Dentistry Approach

The fragment is retained from the lingual gingival connetive tissue attachment

#4 -Trauma Biomimetic Dentistry Approach

Radiograph of the initial condition (fracture).

#5 -Trauma Biomimetic Dentistry Approach

Endodontic treatment is completed and the pulp canal is restored with a biomimetic technique to minimize stress and maximize the bond.

#6 -Trauma Biomimetic Dentistry Approach

Completed treatment- immediate post op. Note that #9 was originally longer than # 8 and was maintained this way.

#7 -Trauma Biomimetic Dentistry Approach

Final after 1 month re-evaluation. No pain or discomfort with stable 2-3 mm pocket depths since 9/22/2011.

Lessons for the Biomimetic Dentist

In our courses, Dave Alleman and I (Matt Nejad) always tell other doctors that part of mastering biomimetic dentistry is understanding the science and the literature in order to treat unique scenarios with a biomimetic approach. Not every case will be a straight forward inlay, onlay, or direct composite restoration and this is why we recommend all biomimetic dentists become experts of the adhesive literature. This case utilized the concepts of immediate dentin sealing and stress reduction to maximize the bond strength and restore an otherwise unrestorable tooth.

Matt Nejad About Matt Nejad

Dr. Nejad graduated from the University of Southern California School of Dentistry with recognition for a record setting amount of fixed prosthodontic procedures completed. He was the youngest dentist to become a clinical instructor at USC, at the age of 26, and he has given lectures on Morphology and Occlusion (since 2010). He is a premiere educator in Biomimetic Dentistry, presenting at numerous conferences by invitation and providing continuing education courses for dentists. He also has private practices in Simi Valley, CA and Beverly Hills, CA.

He has been teaching dentists from around the world, how to improve their adhesive dentistry and provide conservative restorations with the biomimetic approach.

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