Esthetic rehabilitation of complicated crown fractures utilizing rapid orthodontic extrusion and two different restoration modalities

Single-Tooth Rehabilitation Combining Root Displacement and Crown Lengthening Two-Year Follow-Up: A Case Report

CLINICAL RELEVANCE

Combined techniques to expose circumferential tooth structure associated with subsequent restoration may represent a valid option in many situations. This case provides an example of the successful management of the anterior tooth rehabilitation combining root displacement and crown lengthening.

SUMMARY

Rehabilitation of an extensively compromised single anterior tooth represents an intriguing challenge for dentists, particularly when the rehabilitation involves esthetic, psychosocial, and functional requirements. The success in rehabilitating a patient with a conservative approach depends on a critical evaluation of the remaining structures, precise treatment plan, systematic treatment strategies, and patient compliance. In this case, the patient's chief complaint was the undesirable appearance of the maxillary right lateral, caused by the displacement of the post and crown. Clinical examination revealed a remaining tooth with coronal fracture, severe loss of tissue due to caries, and absence of ferrule effect. Radiographic examination revealed that the fracture margin was located subgingival. This case report describes a single-tooth rehabilitation involving a combination of root displacement via orthodontic extrusion and crown lengthening. The rehabilitation was followed by post-and-core restoration using a prefabricated glass fiber post associated with a disilicate lithium crown. The clinical decision making and combined effect of both treatment strategies are explained in this report. The treatment required three months, including recovery times after surgery and the placement of the provisional crown. The patient was esthetically and functionally satisfied with the restoration. Patient follow-up examination was performed 24 months after the treatment. This clinical report contributes to the clinical practice and exemplifies the possibility of rehabilitating the natural tooth using combined techniques, which may offer particular advantages regarding prognosis and invested efforts.

[Digital workflow of orthodontic and prosthetic treatment for subgingival residual root preservation guided by target restoration space]

The use of orthodontic traction to preserve healthy subgingival residual root is a classical method combining the treatment of restoration and orthodontics. Based on the target restoration space (TRS), by establishing a TRS digital model, the final traction position of the subgingival residual root can be preset. After evaluating the key parameters such as crown-to-root ratio and minimum crown height, clinicians can estimate the treatment time and exclude cases with bad preset position. The time of traction treatment can be effectively reduced, and the efficiency and efficacy of the entire treatment can also be improved.

Management of Cervically Fractured Central Incisors: A Multidisciplinary Approach

Introduction:

Fracture of tooth structure at or below the gingival margin compromises rehabilitation and hampers esthetics and function.

Management:

Management of such cases by a post-core and crown restoration, or periodontal surgery or orthodontic extrusion alone may not always suffice in attaining a good result.

Case Report:

A multi-disciplinary approach which includes all of the above mentioned procedures helps in long term success.

Conclusion:

Careful case evaluation, treatment planning and meticulous attention to detail are the keys to the best treatment outcome.