Vertical Coronal Fracture of Maxillary Central Incisor Crown

Patient: This patient had a long history of both nocturnal and daytime bruxism. His medical history was unremarkable.

Description: He presented for his bi-annual cleaning and recall exam. He had no chief complaint.  The craze lines on 8 and 9 were currently being monitored and the patient was due for annual bitewings and a periapical x-ray, if necessary.  The dental hygienist noted that the craze line on #8 extended subgingivally, so she opted to include a periapical radiograph of 8 and 9 was well.  She also took intraoral photographs of #8.

Below is the intraoral picture and radiograph:

Photograph of Maxillary Central Incisor with visible vertical fracture of crown.

Dental X-ray with radiographically visible vertical fracture of crown.

The vertical fracture line on #8 and the smaller one on #9 was not expected.  In my many years of practice I have yet to see another dental x-ray showing this type of fracture with this type of clarity.

With the patient still in the chair, I tested 8 and 9 for vitality with Endo-Ice.  Both tested vital.  In this case, the patient’s age and years of bruxing had contributed to calcification of the coronal pulp chambers. As a result, root canal treatment was not needed.  With these findings and impressive pictures and radiographs, the patient immediately consented to crowns on 8 and 9 and a new nightguard.

8 and 9 were prepared and 3 weeks later all porcelain LAVA crowns were cemented and then impressions were made for an NTI appliance.  The patient has been asymptomatic since then.  I did not take pictures of the tooth preparations or final crowns. I wish I had.  But the fractures are the most impressive part of this case!