Multidisciplinary approach to the management of complicated crown-root fracture: a case report

Abstract

Oblique crown-root fracture in the cervical third of the root is a common event following trauma to the anterior region of the mouth. As a result, sound tooth structure coronal to the attachment apparatus may not be available for restorative needs. Invasion of biological width by fracture line presents a clinical challenge in restorative planning. Placing a restoration margin on sound tooth structure within the dentogingival biological width might result in violation of biological width and should be considered a restorative failure. Maintaining a healthy periodontal attachment apparatus is crucial for long term prognosis and esthetics of the restored tooth. Surgical crown lengthening, surgical extrusion or orthodontic extrusions are the few alternative modalities to expose the fracture line. This case presentation demonstrates a predictable solution in overcoming an oblique crown-root fracture caused by trauma during a road accident. Orthodontic extrusion was used to elevate the fractured tooth from within the alveolar socket to allow the placement of crown margins on sound tooth structure without harming the biologic width. Combining fiberotomy with the extrusion procedure in this case eliminated the need for the surgical procedure. This allowed proper fabrication of post and core and the placement of the crown on sound tooth structure, fulfilling the biological and mechanical principles including obligatory ferrule effect.

Keywords: Circumferential supracrestal fibrotomy; Oblique crown root fracture; Orthodontic extrusion.

Figure 1

(a) Pre-operative labial view, (b) pre-operative palatal view (c) pre-operative radiograph (d) sectional obturation (e) sectional orthodontic appliance (f) circumferential supracrestal fibrotomy (g) crown preparation done.

Figure 2

(a) Porcelain-fused-to-metal crown cemented (b) post-operative radiograph (c) 2 years follow-up radiograph.