Conservative Management of Complicated Crown-Root Fracture: An Immediate Esthetic Rehabilitation

Abstract

Among the various types of dental trauma, crown-root fractures are one of the most challenging to treat and require a multidisciplinary approach. This paper reports a case of a complicated crown-root fracture of maxillary left central incisor with esthetic, functional complications. An 18-year-old male patient presented to the department immediately after suffering trauma with a complicated crown-root fracture on tooth 21. As per the treatment, the patient had undergone endodontic therapy followed by flap reflection. Post flap reflection, a glass fiber post was luted, and the fractured fragment was reattached. By this approach, in the same appointment, the cervical margin can be exposed with appropriate isolation followed by a reattachment procedure. Reattaching the fragment is a viable option as it can be done immediately, provides better esthetics, restores function, and is less complicated than the conventional approach. A good prognosis is dependent on patient cooperation with the understanding of the treatment limitations. The article discusses a successful case of complicated crown-root fracture treated with the reattachment of a tooth fragment. Eighteen months of clinical and radiographic evaluation revealed that the clinical protocol was effective, as the tooth was functional, asymptomatic, and esthetic.

Keywords: complicated crown-root fracture; dental trauma; endodontic therapy; reattachment; tooth fracture.

Figure 1. Preoperative clinical image of tooth 21

Figure 2. Preoperative radiograph of tooth 21

Preoperative radiograph showing fracture line running obliquely from the buccal to the palatal aspect of tooth 21.

Figure 3. Temporary reattachment of the fractured fragment of tooth 21 by flowable composite

Figure 4. Complete root canal treatment of tooth 21

After completion of single-visit root canal treatment of tooth 21.

Figure 5. Clinical picture after removal of the fractured fragment from tooth 21

Figure 6. After removal of the fractured fragment, the segment was kept in normal saline to prevent dehydration till the reattachment

Figure 7. Periodontal flap reflection using the periosteal elevator in relation to tooth 21

Image showing raised palatal and buccal envelope flap by giving crevicular incision from # 11 to # 22 and reflecting using a periosteal elevator.

Figure 8. Immediate postoperative clinical picture after fractured fragment reattachment with tooth 21

Figure 9. Immediate postoperative radiograph after fractured fragment reattachment with tooth 21

Figure 10. Clinical evaluation of tooth 21 after 18 months of fragment reattachment

Figure 11. Radiographic evaluation of tooth 21 after 18 months of fragment reattachment