Effective Reduction of Mental Trauma with a Multidisciplinary Approach to Treatment of Dental Trauma

The purpose of this case report and review is to present the successful management of complicated crown-root fracture of maxillary central incisor with a multidisciplinary approach. A 57-year-old male patient reported with a complaint of unpleasant appearance due to a broken 21. Clinical and radiological examination revealed a complicated oblique crown-root fracture extending below the gingival margin. The tooth was endodontically treated. Surgical crown lengthening with osseous recontouring was performed. After 7 days prefabricated temporary crown was cemented, 6 weeks after surgery fiber post was placed followed by composite core build up. The tooth was restored with a permanent restoration of porcelain fused to the metal crown with gingival porcelain. Examination after 3 months revealed the good periodontal health, esthetic, normal function and patient satisfaction. The key factor in the successful functional and esthetic rehabilitation of a complicated crown-root fracture is weighing of all the available options with a multidisciplinary approach.

Reattachment of complex fractures; a reality by advances in self-etch bonding systems

An 18-year-old female patient reported to the Department of Conservative and Endodontics with the chief complaint of fractured tooth with respect to 21 and increased pain and mobility tooth with respect to 22. Intraoral periapical radiograph of 21 revealed coronal loss of tooth structure involving enamel, dentin, and pulp, suggestive of split tooth with respect to 21. Intraoral examination revealed a fracture of coronal structure of 22 and increased mobility in the coronal aspect, suggestive of horizontal crown–root fracture. For management of 21, after endodontic phase, placement of fiberpost, and coronal buildup, intentional reimplantation was done to expose and reattach the vertically fractured root fragment. For management of 22, after endodontic phase, crown lengthening was done, and the fractured fragment was reattached by making it a Natural Richmond's Crown. Radiographs revealed a complete sealing of the fractured fragment and proper positioning of the tooth.

Resolución integral de una fractura coronorradicular complicada por traumatismo dentoalveolar: informe de un caso / Integral resolution of a complicated crown-root fracture by dentoalveolar traumatism: report of a case

Objetivo: Mostrar una alternativa de tratamiento para las fracturas coronorradiculares complicadas, que restablece la función y la estética de las piezas traumatizadas. Caso clínico: Una paciente de 16 años se presentó en la guardia del Centro Odontológico OSEP tras haber sufrido un accidente vial que le produjo un traumatismo dentoalveolar. El diagnóstico fue fractura coronaria sin exposición pulpar de la pieza dentaria 12 y fractura coronorradicular complicada de la pieza 11. El tratamiento incluyó restauración con resina compuesta de la pieza 12 y endodoncia, extrusión ortodóntica, alargamiento coronario y rehabilitación con perno de fibra de cuarzo y corona de resina compuesta de la pieza 11. Conclusiones: El tratamiento de las fracturas coronorradiculares representa un desafío para el odontólogo. Los resultados del tratamiento, en este paciente, fueron excelentes, ya que lograron devolver estética y función (AU)

Aim: To show an alternative treatment for complicated crown-root fractures, which restores function and aesthetics of the traumatized teeth. Case report: This paper reports the case of a 16-yearold girl who attends the OSEP Dental Center, stating that she had suffered a traffic accident resulting in a dentoalveolar trauma. The diagnosis was a coronary fracture without pulp exposure of tooth 12, and complicated crown-root fracture of tooth 11. Treatment included composite resin restoration of tooth 12 and endodontic, orthodontic extrusion, crown lengthening and rehabilitation with quartz fiber post and composite resin crown of tooth 11. Conclusions: The treatment of crown-root fractures poses a challenge for the dentist. The results of the treatment in this patient were excellent, and aesthetics and function were restored (AU)

One-visit Apexification Using MTA and Reattachment of a Crown-root Fractured Tooth with Severe Coronal Damage: A Case Report / 대한소아치과학회지

In dental trauma, reattachment of the original tooth fragment improves the reproduction of original tooth shape, texture, color, and radiolucency; thus, it provides good aesthetics.A 9-year-old boy was referred due to complicated crown-root fracture of the maxillary right central incisor. Although it had poor prognosis due to severe coronal damage and subcrestal fracture, reattachment of the tooth fragment was chosen due to the patient's age. One-visit apexification with mineral trioxide aggregate (MTA) was performed, followed by osteotomy and reattachment of the tooth fragment with post placement.Regular observation revealed no clinical signs or symptoms and no radiologic complications.

Clinical application of intraalveolar transplantation for the teeth with complicated crown-root fracture / 实用口腔医学杂志

Objective: To observe the clinical effect of the intraalveolar transplantation for upper anterior teeth with crown-root fracture. Methods: 18 Maxillary anterior teeth with crown-root fracture in 15 cases were included. Surgical extrusion with 180° rotation of the dental remnant was performed for the teeth with deep fracture line at the palatal side,and without rotation for the deep fracture line at labial side. After root canal therapy with Metapex under local anesthesia,the roots were surgical extracted to the required position and fixed to adjacent teeth by interdental suture and flexible fiber strip splint. 1 week after operation the suture was removed,3 to 4 weeks later the splint was removed and root canal therapy was conducted,then the teeth were repaired by composite resin crown /post-core crown. Clinical and radiographic examinations were performed at 1 month,3 months,6 months and 3 years after treatment. Results: The average 4 mm extrusion was acquired for the 18 teeth. All patients were satisfied with the treatment outcome and can exercise the normal function. The first 1 to 3 month after surgery,the mobility was less than 1°,periodontal soft tissue was healthy. X-Ray examination showed periapical bone density was significantly increased from the periapical to the alveolar ridge. 3 to 6 months after treatment,the crestal bone resorption was not further developed,angular absorption image disappeared,and complete new bone was formed in the periapical area. 6 months postoperatively,lamina dura was observed in the alveolar bone in almost all of the teeth. Labial gingiva of 10 teeth(55. 56％) was mild retreat(≤1 mm) compared with adjacent teeth. Conclusion: Intraalveolar transplantation method is effcective and time-saving in the treatment of the tooth with complicated crown-root fracture.

Treatment of complex crown-root fracture / 华西口腔医学杂志

With the development of the oral clinical technology and materials, the concept of complex crown root fracture has become more scientific and developed. Epidemiological characteristics, causes and clinical features of this disease are generalized. Aesthetic, functional and minimally invasive coordination is reflected by expounding the diagnosis of complex crown-root fracture, recommendation of treatment and techniques, and characteristics of immature permanent teeth to systematize the treatment strategy, and to guide the clinical therapy of complex crown-root fracture.

Esthetic enhancement of a traumatized anterior tooth with a combination of forced eruption and tooth alignment: a case report

Exposing sound structure of a subgingivally fractured tooth using orthodontic extrusion is considered to be a conservative way to re-establish biologic width without sacrificing esthetics or jeopardizing periodontal support of neighboring teeth. When a misaligned tooth is traumatically involved, a more comprehensive approach combining tooth extrusion and re-alignment may be necessary for a successful restorative outcome. This case report describes a successful esthetic management of a patient with complicated crown-root fracture on the maxillary right central incisor and pre-existing malocclusion in the maxillary anterior region. Forced eruption along with re-alignment of teeth by orthodontic movement seems to allow re-positioning of the fracture line to a favorable position and correction of crowding, providing a better esthetic result.

Orthodontic extrusion of subgingivally fractured tooth using a removable appliance: An alternative treatment to reestablish biological width.

Restoration of a traumatically injured tooth presents a clinical challenge for a predictable aesthetic outcome. This case report describes a multidisciplinary approach of a subgingivally fractured permanent maxillary central incisor. A removable orthodontic appliance was used for orthodontic extrusion of root, and surgical gingival recontouring was done with electrocautery to reestablish the biological width. Form and function were restored establishing biological width and esthetics was repaired with porcelain fused to metal crown.

Multidisciplinary approach for crown-root fracture treatment after trauma: case report / Abordagem multidisciplinar para tratamento de fratura corono-radicular pós-traumatismo: relato de caso

The development of an accurate diagnosis and appropriate treatment plan can be a complex task, especially in cases of dentoalveolar trauma. The authors present a case report of crown-root fracture caused by trauma and highlight the importance of a multidisciplinary approach for the treatment. An eighteen year-old boy had a bicycle accident resulting in dental trauma. The upper right first molar showed a complicated crownroot fracture and the lower left second pre-molar showed an uncomplicated crown-root fracture. Endodontic treatment, controlled tooth extrusion, periodontal surgery for recovery of biological width, and porcelain crown and onlay restorations were performed. Esthetic and functional results were achieved. At the two-year follow-up it was observed that the tooth/onlay interface of the upper right first molar was stained and the onlay of the left lower second pre-molar was fractured. Therefore, the interface stained was repaired and a porcelain crown was made for the lower second premolar. The clinical case presented herein leads to the conclusion that a multidisciplinary treatment plan is extremely important for a proper resolution in cases of dentoalveolar trauma

A elaboração de um diagnóstico preciso e de um plano de tratamento adequado pode constituir uma tarefa bastante complexa, especialmente nos casos de traumatismos dentoalveolares. O relato de caso teve por finalidade demonstrar a importância da abordagem multidisciplinar para o tratamento de fratura corono-radicular pós traumatismo. Paciente de 18 anos de idade, gênero masculino, sofreu uma queda de bicicleta resultando em traumatismos dentários. O 16 sofreu fratura corono-radicular complicada e o 35 fratura corono-radicular não-complicada. Foi realizado tratamento endodôntico, extrusão dentária controlada, cirurgia periodontal para recuperação do espaço biológico, coroa de porcelana e restauração tipo onlay. O resultado estético e funcional foi alcançado. O paciente foi acompanhado por 2 anos onde foi observado um manchamento na interface dente/onlay do 16 e fratura da onlay do 35. Foi realizado um reparo na interface do 16 e confeccionada uma coroa de porcelana para o 35. Foi possível concluir que a multidisciplinaridade do plano de tratamento é de extrema importância para uma adequada resolução dos casos de traumatismos dentoalveolares

Fratura coronorradicular: uma abordagem multidisciplinar / Crown-root fracture- a multidisciplinary approach

Introdução: Uma fratura coronorradicular envolve esmalte, dentina e cemento, podendo ou não haver comprometimento pulpar. Vários tratamentos são propostos na literatura, desde a colagem do fragmento dental até a extrusão cirúrgica do fragmento remanescente. O presente trabalho descreve um caso de fratura coronorradicular com envolvimento pulpar e a abordagem multidisciplinar dada ao caso. Descrição do Caso Clínico: Paciente procurou tratamento odontológico por causa de um "dente quebrado". O tratamento realizado consistiu em um retalho mucoperiosteal para remoção dos fragmentos dentais, tratamento endodôntico, restauração provisória, extrusão ortodôntica, uma nova restauração e a proservação do caso. Conclusão: Em pacientes jovens, na região anterior, a extrusão ortodôntica acompanhada do tratamento restaurador é uma opção de tratamento conservador e estético.

Introduction: A crown-root fracture involves enamel, dentin and cementum. There may or may not be pulp involvement. Several treatments are proposed in the literature, going from a simple bond of dental fragments to surgical extrusion of the dental remaining fragments. The article describes a case of crown-root fracture with pulp involvement, and the multidisciplinary approach applied to the case. Case Report: Patient required dental treatment due to a "broken tooth". The treatment consisted in a mucoperiosteal flap to remove dental fragments, endodontic treatment, temporary restoration, orthodontic extrusion, a new restoration, and the follow-up of the case. Conclusion: While treating the anterior teeth of young patients, the orthodontic extrusion accompanied by restorative treatment is the most conservative and aesthetic option of treatment.

Conservative and aesthetic emergency management in adolescent with complex crown-root fracture and simultaneous oblique root fracture in upper maxillary central incisor: clinical outcome after 18 months follow-up period / Manejo de urgencia conservador y estético en adolescente con fractura corono radicular complicada y fractura radicular oblicua simultanea en incisivo central maxilar: resultado clínico después de 18 meses de seguimiento y control

Emergency treatment of 11- years-old female patient, presenting a complicated crown root fracture, which simultaneously presented oblique root fracture in the maxillary right central incisor. In order to expose the subgingival extension of the fracture, it was necessary to raise a mucoperiosteal flap. In light of pulp exposure, and prior to the repositioning of fragments with adhesive composite resin technique, Cvek pulp therapy was performed . Despite the existence of a 4-5 mm subgingival extension, neither surgical nor orthodontic extrusion of the root fragment was performed due to the presence of intra-alveolar oblique root fracture without displacement. Minimally invasive and conservative clinical management is basic, namely due to the great capacity of pulp healing in young permanent teeth, the absence of displacement between fragments of root fracture, and great capacity of adhesion and tensile strength of current adhesive systems. Clinical and radiographic controls over the first 18 months have shown an excellent pulp response, with some minor periodontal complications in relation to the biological width invasion and an adequate functional and aesthetic result.

Se presenta el tratamiento de emergencia de una adolescente, sexo femenino, de 11 años de edad que sufre una fractura corono radicular complicada compleja, y que en forma simultánea presenta fractura radicular oblicua en incisivo central superior derecho. Para exponer la extension subgingival de la fractura, fue necesario levantar un colgajo mucoperióstico. Debido a la exposición pulpar, y previo a la reposición de fragmentos con técnica adhesiva de resina composite, se realizó una terapia pulpar de Cvek. A pesar de existir una extensión subgingival de 4-5 mm, no se realizó la extrusión quirúrgica ni ortodóncica del fragmento radicular debido a la presencia de fractura radicular oblicua intra-alveolar sin desplazamiento. El manejo clínico conservador y de mínima invasión es fundamentado principalmente por la alta capacidad de de cicatrización pulpar en dientes permanentes jóvenes, la ausencia de desplazamiento entre los fragmentos de la fractura radicular, y la alta capacidad de adhesión y resistencia a la tracción de los sistemas adhesivos actuales. Los controles clínicos y radiográficos durante estos primeros18 meses han mostrado una excelente respuesta pulpar, solo algunas complicaciones periodontales menores en relación a la invasión del ancho biológico y una adecuado resultado funcional y estético.

Clinical management of a complicated crown-root fracture: a case report

This report describes the clinical procedures involved in the treatment of a complicated crown-root fracture in the maxillary left central incisor with a wide open apex of a 10-year-old male patient, due to fall from his own height. Post-trauma treatment comprised cervical pulpotomy and adhesive tooth fragment reattachment. After 1 year, clinical and radiograph examinations showed pulp necrosis and an associated periapical lesion. Endodontic therapy with calcium hydroxide-base intracanal dressing, root canal filling and orthodontic extrusion were performed. Extrusion was completed within approximately 16 weeks and the tooth was restored with a post-core system and a prosthetic crown. After a 3 years of follow-up, there was no evidence of apical periodontitis and the tooth was satisfactory both esthetically and functionally.

Este relato de caso apresenta os procedimentos clínicos envolvidos no tratamento de um caso de fratura corono-radicular complicada de um incisivo superior esquerdo com ápice aberto de um paciente de 10 anos de idade devido à queda da própria altura. O tratamento envolveu pulpotomia cervical e fixação do fragmento. Após 1 ano, os exames clínicos e radiográficos demonstraram necrose pulpar e lesão perirradicular associada. O tratamento endodôntico foi realizado com a utilização de pasta de hidróxido de cálcio, obturação endodôntica e extrusão ortodôntica. Após aproximadamente 16 semanas, o processo de extrusão foi finalizado e o dente restaurado com pino e coroa protética. Após acompanhamento de 3 anos, não havia evidência de lesão perirradicular e o dente estava estética e funcionalmente satisfatório.

Treatment of crown-root fracture with a modified crown fragment reattachment technique / 대한치과보존학회지

The development of adhesive dentistry has allowed that the crown fragment reattachment can be another option in the treatment of crown fracture. However, additional crown lengthening procedure or extrusion of the tooth may be necessary in the treatment of crown root fracture because subgingival fracture line in close proximity to the alveolar bone leads to challenges for restorative procedure and the violation of the biologic width. This case report presents a modified crown fragment reattachment technique of crown root fracture with pulp exposure, which was done without additional crown lengthening procedures. After the endodontic treatment, the patient was treated using a post insertion and the fragment reattachment technique, which made it possible to preserve the space for the biologic width and maintain a dry surgical field for adequate adhesion through the modification of the fractured coronal fragment. Since a coronal fracture was occurred and reattached afterward, it was observed that the coronal fragment was well maintained without the additional loss of periodontal attachment through 2-year follow up.

Complicated crown root fracture treatment option: a case report

Complicated crown-root fractures are rare and often need complex treatment planning. This paper describes a simplified treatment option for a complicated crown root fracture that minimally encroached into the biologic region in a growing child without the need for surgery or orthodontic treatment.

Fracture resistance of crown-root fractured teeth repaired with dual-cured composite resin and horizontal posts / 대한치과보존학회지

The purpose of this study was to investigate the fracture resistance of crown-root fractured teeth repaired with dual-cured composite resin and horizontal posts. 48 extracted human premolars were assigned to control group and three experimental groups. Complete crown-root fractures were experimentally induced in all control and experimental teeth. In the control group, the teeth (n=12) were bonded with resin cement and endodontically treated. Thereafter, the access cavities were sealed with dual-cured composite resin. In composite resin core - post group (n=12), the teeth were endodontically treated and access cavities were sealed with dual-cured composite resin. In addition, the fractured segments in this group were fixed using horizontal posts. In composite resin core group (n=12), the teeth were endodontically treated and the access cavities were filled with dual-cured composite resin without horizontal posts. In bonded amalgam group (n=12), the teeth were endodontically treated and the access cavities were sealed with bonded amalgam. Experimental complete crown-root fractures were induced again on repaired control and experimental teeth. The ratio of fracture resistance to original fracture resistance was analyzed with Kruskal-Wallis test. The results showed that teeth in control and composite resin core - post group showed significantly higher resistance to re-fracture than those in amalgam core group (p < 0.05). The resistance to refracture was high in the order of composite resin - post group, control group, composite resin group and bonded amalgam group. Within the scope of this study, the use of horizontal post could be beneficial in increasing the fracture resistance of previously fractured teeth.