Asked for a second opinion, I once again encountered the staggering fact that there are still dentists who would treat these sorts of fractures with full crowns:
The patient tells me that the treatment so far has been composite resins, and they have fractured several times. There is an issue with poor canine guidance here, and orthodontics would provide far-reaching benefits in terms of force distribution on this patient's teeth. They are giving orthodontic treatment strong consideration. But the other problem is that tooth enamel is relatively inflexible, and composite resin is relatively flexible. In some situations where forces and tooth flexure are high, the composite snaps off due to the mismatch in flexibility, or modulus of elasticity.
So, rather than improving the occlusion, matching moduli and employing the principles of dental adhesion, some dentists would apparently sail right on past veneers and treat this situation with full crowns.
I'm sorry, but: idiots.
Crowns here are over-treatment, plain and simple, in this new world of dental adhesion we inhabit. (Plus--what if they break too? What then?) One of the many reasons to conserve tooth structure: look at how big the patient's pulps are! We have an obligation to protect young pulps, and crown preps (and bacterial microleakage) would come awfully close to them in this case. The risk of root canal is high here if crowns are done on these young teeth.
Even veneers are rather aggressive in this situation, though they make more sense than full crowns. Sectional Veneers (made of porcelain) are the finest way to treat such tooth fractures as these today. They match shades the best because porcelain does not stain with time and most of the enamel remains the patient's own. They match moduli the best too, because porcelain's modulus is a lot closer to tooth enamel than is composite resin's.
And just to clarify: composite resins offer beauty, longevity and a great cost-to-benefit ratio in anterior tooth fractures like these. It's generally best to try them first. If they fail multiple times, though, improving the occlusion and placing sectional porcelain veneers is excellent and tooth-conserving treatment.
Here is an immediate post-op photo of the sectional veneers in place. My patient and his family plan to proceed with orthodontics under the care of an excellent orthodontist. The improvements in occlusion and load distribution will provide even more protection to these teeth and the beautiful porcelain restorations that form their edges.
*Sectional Veneers created by Pyramid Dental Labs, Elkins Park, PA.