Revascularization of an Immature Permanent Central Incisor with Complicated Crown Root Fracture: A Case Report

Abstract

The treatment of complicated crown root fracture in children possesses a great challenge to pedodontists. A 10-year-old boy presented with trauma to the permanent maxillary left central incisor. Upon clinical and radiographic examination, revealed mobility of coronal fragment, open apex, and vertical fracture involving enamel dentin and pulp. Instead of the standard root canal treatment protocol, revascularization was performed after stabilizing the coronal fragment. The detachment of the coronal fragment occurred following a fall for the second time after 1 month of placement of mineral trioxide aggregate (MTA) over the blood clot. The coronal seal was intact; hence, the coronal fragment was reattached and the crown was placed. At 12-month follow-up, clinical and radiographic evaluation showed that the tooth was asymptomatic and functional. With increasing scope of clinical facts, patient, and practitioner favorable reception, regenerative techniques may be used as a standard technique in treating complicated crown root fracture in young permanent teeth.

How to cite this article: John A, Hegde AM, et al. Revascularization of an Immature Permanent Central Incisor with Complicated Crown Root Fracture: A Case Report. Int J Clin Pediatr Dent 2019;12(1):59-63.

Keywords: Crown root fracture; Immature teeth; Revascularization.

Fig. 1

Patient's anterior tooth no. 21 showing vertical fracture and step deformity of the coronal fragment

Fig. 2

Periapical radiograph of the permanent left central incisor showing open apex, vertical fracture involving enamel, dentin, and pulp and extending up to 3 mm above the cervical line

Fig. 3

Patient's anterior tooth on the removal of the coronal fragment

Fig. 4

Patient's anterior tooth on the removal of the coronal fragment (posterior view)

Fig. 5

Patient's anterior tooth (no. 21) after stabilizing the coronal fragment

Fig. 6

Periapical radiograph taken after stabilizing the coronal fragment

Fig. 7

Mineral trioxide aggregate placement at the cervical level after the blood clot was formed

Fig. 8

3-month follow-up showing early stages of apexogenesis

Fig. 9

Detachment of coronal fragment after the second fall (anterior view)

Fig. 10

Detachment of coronal fragment after the second fall (posterior view)

Fig. 11

Acrylic crown cemented on tooth no. 21

Fig. 12

6-month follow-up showing continued apexogenesis

Fig. 13

1-year follow-up showing continued apexogenesis and dentinal wall thickening