Jacket Crown for a Traumatized Front Tooth

Case Study

Restoring a Young Smile

At Anna Nagar Dental Clinic, Dr. K. Seethalakshmi recently performed a Jacket crown done for upper front teeth for a patient who presented with a complaint of a broken upper front tooth.

A 14-year-old patient recently visited Anna Nagar Dental Clinic with a common yet distressing issue: a fractured upper front tooth, along with associated pain and swelling.

The trauma had initially occurred three months prior, but the patient only sought treatment when symptoms became acute. Dr. K. Seethalakshmi quickly developed a comprehensive treatment plan, guided by a diagnostic OPG X-ray to assess the underlying dental structure.

The diagnosis revealed that her pre-existing dental issue—significant crowding and misalignment of her front teeth—was a key factor that made the tooth vulnerable to fracture upon trauma.

The goal, therefore, was twofold: first, to perform Root Canal Treatment (RCT) to save the damaged tooth (tooth #11) and immediately restore its appearance with a Jacket Crown (JC); and second, to plan for future orthodontic correction (braces) to ensure a healthy, stable, and aesthetic long-term outcome.

Key Findings & Treatment Strategy:

Underlying Cause: The patient presented with malaligned and crowded teeth, which unfortunately made the tooth more susceptible to fracture upon trauma.
Initial Focus: To address the immediate pain and save the tooth, the first step was Root Canal Treatment (RCT) on the broken tooth (Tooth #11).
Temporary Restoration: Following the RCT, a Jacket Crown (JC) was necessary to restore the tooth’s appearance and function. Since the patient also required Fixed Appliance (FA) braces to correct the underlying crowding, we opted for a temporary Acrylic Resin Jacket Crown.
The Long-Term Plan: The initial acrylic crown will be replaced with a permanent, high-quality aesthetic crown, such as Ceramic or Zirconia, once the orthodontic treatment (braces) is complete and the teeth are properly aligned.

Stages of Treatment at Anna Nagar Dental Clinic:

Root Canal Treatment (RCT) on the fractured tooth.
Post and screw fixation for added internal support.
Core buildup to prepare the tooth structure.
Tooth preparation for the Jacket Crown.
Fixation of the temporary Acrylic Resin Jacket Crown.
Next Step: Commencement of orthodontic treatment (braces) for proper alignment.
Final Step: Replacement of the temporary crown with a definitive Ceramic or Zirconia crown.
Outcome: We successfully eliminated the infection and restored the patient’s smile, establishing a strong foundation for future orthodontic and definitive cosmetic treatment.

Restoring a Tooth: From Root Canal to Final Crown

The Restoration Process: Post and Core Buildup: Immediately after the root canal treatment was completed, the following restorative steps—known as a post and core buildup—were performed in the same appointment to strengthen the compromised tooth structure:

Placing the Internal Support (The Post): A metal post was carefully cemented deep into the root canal space. This is essential for anchoring the final restoration, providing necessary strength to the tooth, and preventing the crown from falling out.
Rebuilding the Tooth (The Core): A durable light-cured composite resin (a tooth-colored filling material) was then packed around the metal post. This process, called the core buildup, effectively rebuilds the missing structure of the tooth, restoring its general shape and creating a stable base.

Preparing for the Crown

With the core buildup complete, the tooth is prepared to receive the custom-made Jacket Crown:

1. Shaping the Foundation (Tooth Reduction): The newly rebuilt tooth structure was precisely contoured and reduced. This step ensures that when the final Jacket Crown is placed, it will fit perfectly over the core without adding bulk, ensuring a natural appearance and proper bite.

Finalizing the Crown: Impressions and Placement

Taking the Impressions: A detailed master impression of the prepared tooth and surrounding teeth was taken, along with a wax bite (to record the patient’s bite) and a shade selection (to match the color of the patient’s natural teeth). All this information was sent to a dental laboratory to custom-fabricate the Acrylic Jacket Crown (JC).
Fitting the Crown: Once the finished crown was received from the lab, a trial fitting was performed to ensure optimal fit, margin seal, and aesthetics. After confirming the fit was perfect, the crown was permanently bonded to the prepared tooth using a specialized luting cement.

Post-operative Care

Proper care is essential to ensure the longevity and beautiful appearance of your new Jacket Crown (JC). Please adhere to the following guidelines:

Understanding the Function of Your Crown

Aesthetics First: Your Jacket Crown provides a highly aesthetic and natural appearance. While it helps with functions like speech and the clear pronunciation of certain words, its primary role is not for heavy chewing.
Limit High-Impact Function: It is crucial to understand that crowns on front teeth are designed primarily for tearing and not for forceful, direct biting or tearing of hard or sticky foods.

Daily Care and Precautions

Gentle Hygiene is Key: Be cautious and gentle when brushing and flossing around the crown. Use a soft-bristled toothbrush and maintain excellent oral hygiene to keep the gums healthy around the restoration.
Avoid Direct Front Biting: Do not use the crowned front tooth for direct biting into hard or tough foods (e.g., apples, crusty bread, carrots, hard candy). Instead, cut these foods into smaller, manageable pieces and chew with your back teeth.
Prevent Staining and Damage:
- Minimize consumption of aerated beverages (sodas) and highly colored food/drinks (coffee, tea, red wine, turmeric-heavy curries). While the crown material is generally stain-resistant, excessive consumption can affect the surrounding natural teeth and the crown’s margins.
- Absolutely avoid chewing on non-food items like pen caps, fingernails, or ice, as this can crack or dislodge the crown.

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