Complicated crown fractures - management and treatment options

Holistic management of complicated crown fracture: A case series

Coronal fractures of the anterior teeth give an agonizing experience for a young individual due to the physical disfigurement, and the psychological impact that is imposed on them. One of the options for managing complicated/uncomplicated crown fractures when the tooth fragment is available, and there is no or minimal violation of the biological width is the rebonding of the fractured segment. This treatment approach is promising, providing good and long-lasting esthetics as it helps in maintaining the tooth's original anatomic form, hue, and surface texture. This article describes three case reports of successful reattachment of fractured tooth fragments. Following the root canal treatment procedures, prefabricated posts were cemented as intraradicular splint to reattach the fractured segments.

Complicated Crown Fracture of Permanent Incisors: A Conservative Treatment Case Report and a Narrative Review

Dental trauma may have a severe impact on the social and psychological wellbeing of a patient. Most cases of dental injuries involve anterior teeth, especially the maxillary upper incisors. Crown fractures, with or without pulp exposure, are the most common trauma in permanent dentition. There are many methods of management, in which the initial state of the pulp, the time since the injury, and the presence of an accompanying injury play a key role. This case report aimed at showing a possible conservative treatment after complicated tooth fracture that consisted of partial pulpotomy followed by adhesive reattachment of the tooth fragment using a technique based on heated resin composite. Such a specific procedure represents a conservative approach to traumatic coronal lesions, providing a suitable opportunity to maintain the tooth vitality, aesthetics, and function. Indeed, reattachment of tooth fragment using a composite/adhesive is a simple technique to achieve excellent results in terms of aesthetic and function.

Conservative Treatment of Complicated Crown Fracture and Crown-Root Fracture of Young Permanent Incisor-A Case Report with 24-Month Follow-Up

The complicated crown-root fracture of young permanent teeth is an uncommon traumatic dental injury that is usually treated in a complex way and is demanding not only for the dentist but even for the treated child. In this case report, we present the conservative treatment of a maxillary central incisor in a 10-year-old boy after a traumatic dental injury. Treatment included partial pulpotomy and adhesive fragment reattachment after reflection of the mucoperiosteal flap. The patient was fully asymptomatic at 24-month follow-up, with an aesthetically acceptable outcome. Vital pulp therapy and adhesive fragment reattachment can be a viable treatment option for complicated crown-root fractures, especially when treating immature permanent teeth.

Influence of Root Canal Posts on the Reattachment of Fragments to Endodontically Treated Fractured Incisors: An in vitro Experimental Comparison

OBJECTIVE

The aim of this study was to establish the benefits of inserting a fiberglass post when bonding tooth fragments after complicated coronal fractures.

METHODS

Thirty bovine incisors were randomly assigned to three groups: a control group of intact teeth (A), and two experimental groups (B and C). Coronal fragments were cut from the teeth in groups B and C, which then underwent root canal treatment, inserting posts in the teeth in group C. The coronal fragments were bonded to the teeth in both experimental groups using the same materials and technique, then the specimens were submitted to mechanical loading until fracture.

RESULTS

The specimens in the experimental groups had a lower resistance to mechanical loading than the intact teeth. The mean failure load was: 352.77 (SD ± 62.22) N in group A, 151.04 (SD ± 45.76) N in group B, and 168.61 (SD ± 33.59) N in group C. The difference between group A and the other two groups was statistically significant (analysis of variance test: p < 0.0001), whereas there was no statistically significant difference in the force needed to fracture the teeth in groups B and C (Tukey's test: p = 0.34). When the failure mode under loading was examined, the fractures in group C never involved new tooth substance beneath the adhesion interface, whereas in group B, this was only true in one in two cases.

CONCLUSIONS

Inserting a post does not significantly improve the strength of restored teeth, but it may result in a more favorable fracture mode.

CLINICAL SIGNIFICANCE

Within the limitations of this in vitro study, reattaching the fragment of a fractured tooth does not seem to restore the tooth to its original load resistance. The findings of this study indicate that inserting a fiberglass post for reinforcement purposes in fractured teeth undergoing root canal treatment is unable to significantly improve their load-bearing capacity by comparison with teeth repaired without inserting a post. However, the results of the present study suggest that inserting a post may result in a more favorable fracture mode in the event of further trauma.

An esthetic appliance for the management of crown-root fracture: a case report

Orthodontic extrusion is usually performed by means of a fixed orthodontic appliance that utilizes arch wire attached to adjacent teeth and transfers the desired force by elastic from the wire to the root. However, clinicians often encounter cases where the bonding required for tooth traction is not possible because the adjacent teeth have been restored with ceramic or veneer. The purpose of this case report is to describe a modified orthodontic extrusion appliance that is useful when conventional orthodontic treatment is not possible. The modified appliance was fabricated using an artificial tooth, clear plastic sheeting, and a braided fiber-reinforced composite strip that covered adjacent teeth without bonding. It satisfied the esthetic and functional needs of the patient and established the optimal biologic width.

Fratura coronorradicular: uma abordagem multidisciplinar

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.