Heroic Dentistry: Trauma, External Resorption, Extraction, and Splinting the Natural Crown with ACTIVA

By Dr. Lukasz Balcerzak

The Heroic Dentistry series celebrates oral health care providers who, like PULPDENT founder Dr. Harold Berk, have made it their mission to save teeth and help patients live in comfort and smile with confidence.

Adam has been my patient since I started in private practice 16 years ago. Now 28 years old, he is a delightful but seriously compromised young man who has been confined to a wheelchair all his life.

This chapter of Adam’s dental story began in 2012 when he took a fall from his wheelchair and broke his upper central incisors #11 and 21 (8 and 9). With his face bloodied, and with the help of the local police, he arrived at my office, and I repositioned both teeth and secured them with a composite split. A few days later, I performed endodontic treatments.

Cracked crown due to external resorption on tooth #11

All was well until August 2018 when a radiograph showed massive external resorption in tooth #11 (8). Beyond repair, we waited for the inevitable, and in November 2018, the crown of #11 (8) broke beneath the gum line.

My oral surgeon spent an hour carefully removing the root to minimize damage to the bone. I kept the crown of the tooth stored in sodium hypochlorite, and I decided that the best treatment for Adam was to use his natural tooth for the restoration.

After extraction.

Three weeks after the extraction of the root, the natural crown of the tooth was cemented back in its place. For additional support, I connected it to teeth 12 and 21 (7 and 9) with a lingual fiber splint (Angelus) bonded with DenTASTIC UNO adhesive and ACTIVA BioACTIVE-RESTORATIVE (Pulpdent), which has the ideal flow for this indication.

The natural tooth crown is cemented to place with flowable composite.

It was a long, back-aching appointment, but Adam’s smile was back, his mom was in tears of joy, and for me it was a most rewarding afternoon and what I love most about being a dentist.

The final result.

Dr. Lukasz Balcerzak graduated in 2001 from the Medical University in Poznan, Poland with a specialization in Dentistry. He comes from a family of dental professionals. His grandfather became a dental technician shortly after World War II in Konin, Poland where he practiced well into his eighties. Dr. Balcerzak’s mother, Hanna Szymanska Balcerzak, is also an alumna of Poznan’s Medical University with many years of experience in her specialty, prosthetics. Together with his mother, Dr. Balcerzak’s practice, B & S-DENT, employs a team of dentists each with his or her own specialty. The practice’s motto is “SAVE THAT TOOTH.”

Dr. Balcerzak has participated in domestic and international conferences, lectures, seminars, and dental courses. Dr. Balcerzak is the author of many dental articles, with a particular focus on bioactive materials, and organizes workshops in Poland to teach dentists how to optimally use bioactive materials in their practices.