Published in March 1987
Flap apically repositioned with fibrin glue in the treatment of a lingual coronal fracture extending below the gingival level and under the bony crest (Ingle's class IV of a dental element 4.7).
Physician and Surgeon specializing in Dentistry. Periodontist.
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The author exams a clinical case of the fracture of the lingual wall of a second lower molar. The fracture extends itself under the bony crest. Such cases often discourage the dentist, however, many can be recovered. A simple bony resecting operation along with apical resetting of the flap, this one stabilized with human fibrin glue, is quite enough to expose the fracturated margin and thus to restore rationally the involved dental site.

Key words: Apically repositioned flap set with human fibrin glue

Figs. 1-1a
Fracture of the lingual wall of 4.7.
Fig. 2 The rima of the fracture is fluted and slightly involves the beginning of the bifurcation.
Fig. 3-3a X-rays of the fractured and healthy tooth respectively: the fracture is apical to the bony crest.
Fig. 4-4a The fracture is abundantly subgingival.
Fig. 5-5a
A mucoperiosteal flap is sculpted.
Fig. 6-6a
The exposed bony crest is coronal with respect to the rima of the fracture.
Fig. 7
Following osteotomy and osteoplastics the hard, healthy tissues of the tooth are suitably exposed.
Fig. 8-8a After preparing the traditional suture with two single safety stitches, not yet tied off, two drops of human fibrin glue are applied.

Fig. 9a-9 After lightly compressing the flap for three minutes, the flap is stabilized by the glue in the apical position with its coronal margin at the level of the new bony crest.
Fig. 10-10a After 40 days it is possible to see a correct print.

Fig. 11-11a Construct a temporary crown with coronal closure with respect to the epithelial attachment, with full consideration for adherance


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