For a long time, the primary choice for initial restoration of a crown-fractured front tooth has been resin composite material. The restoration can in most cases be performed immediately after injury if there is no sign of periodontal injury. The method’s adhesive character is conservative to tooth-structure and with minimal risk of pulpal complication. In addition, it offers an aesthetic solution to the patient immediately after an injury, which may bring a little comfort in a sad situation.
The resin composite build-up is often changed or repaired a couple of times, before the tooth is restored with a porcelain or porcelain fused to metal crown, at a time when the pulp is out of danger for a more invasive preparation. In some cases an endodontic treatment is still neces-sary. After crown therapy a gingival inflammation may occur due to the usual sub-gingival prepara-tions. After some years in situ, the crowns may present an aesthetic problem due to exposure of un-aesthetic crown-margins. The invasive permanent crown restorations are therefore often not suc-cessful on a long-term scale. On the other hand, a conservative direct restoration of an extensively fractured incisor crown with resin composite may be an exceedingly demanding procedure, involv-ing aesthetic acceptability, function and biological aspects and require significant skills, which may influence durability.
When are we ready to consider the non-invasive resin composite crown build-up as a permanent restoration? Has its durability improved? Do today’s materials and techniques result in a better prognosis? Where are the problems? In this chapter these matters will be discussed with focus on factors in clinical procedures, which can influence the longevity of the restoration.