Multidisciplinary approach of a crown-root fracture using intentional replantation: a case report

Crown-root fractures are complex traumatic injuries that require multidisciplinary management and afford uncertain prognosis. The purpose of this clinical article was to report the case of crown-root fracture where a multidisciplinary approach was successfully executed. A 10-year-old male patient who suffered a complicated crown-root fracture on a permanent maxillary central incisor was treated using an intentional 180°-rotation replantation technique, followed by endodontic therapy and restoration with resin composite. Two years after the initial treatment, the case was stable and the tooth was restored with a resin core and a ceramic crown. This article describes how adequate multidisciplinary treatment planning, coordination, and execution are necessary for similar cases to be properly managed. It can be concluded that the intentional replantation with 180°-rotation allowed a more conservative approach, showing, in this case, a clinical success without resorption.     

Multidisciplinary treatment approach for crown fracture and crown-root fracture – a case report

Abstract –  The increased incidence of traumatic injuries to anterior teeth is a consequence of leisure activities, where the most common injuries are crown fractures. Treatment of the dental trauma is complex and requires a comprehensive and accurate diagnostic and treatment plan. It is also important to consider the biological, functional, esthetic and economic aspects, as well as the patient's desire. The purpose of this article is to report a case that shows the multidisciplinary approach required to successfully manage the rehabilitation of a maxillary central incisor with a complex crown fracture and a maxillary lateral incisor, that at first presented an oblique crown-root fracture, and after the orthodontic extrusion, suffered a more apical new crown-root fracture.     

Clinical management of a complicated crown-root fracture: a case report

This report describes the clinical procedures involved in the treatment of a complicated crown-root fracture in the maxillary left central incisor with a wide open apex of a 10-year-old male patient, due to fall from his own height. Post-trauma treatment comprised cervical pulpotomy and adhesive tooth fragment reattachment. After 1 year, clinical and radiograph examinations showed pulp necrosis and an associated periapical lesion. Endodontic therapy with calcium hydroxide-base intracanal dressing, root canal filling and orthodontic extrusion were performed. Extrusion was completed within approximately 16 weeks and the tooth was restored with a post-core system and a prosthetic crown. After a 3 years of follow-up, there was no evidence of apical periodontitis and the tooth was satisfactory both esthetically and functionally.     

A multi-disciplinary approach in the management of a traumatized tooth with complicated crown-root fracture: A case report

A 13-year-old boy had fractured his maxillary right central incisor. The fracture line involved 2/3rd of the crown, compromising the pulp and extended subgingivally on the palatal aspect invading the biologic width. The procedure used to manage this case included endodontic treatment of residual tooth orthodontic extrusion to move the fracture line above the alveolar bone. Finally the tooth was restored prosthodontically.     

Multidisciplinary approach to the rehabilitation of a crown-root fracture with original fragment for immediate esthetics: a case report with 4-year follow-up

Abstract –  Dental practitioners frequently encounter dentoalveolar traumas. According to the severity of the trauma, a large spectrum of complications such as isolated tooth fracture, dentoalveolar fracture or fracture at maxillofacial region may occur. If the isolated tooth fracture occurs particularly at anterior region, the rehabilitation should satisfy both esthetic and functional problems. An unrestorable tooth should be extracted and this leads to more complex treatments such as implant or conventional prosthetic rehabilitations, which will restore the function, but impair the esthetics. Recently, powerful new generation dual-cured resin composites have been produced for reattachment of original fractured fragments. In this case, we presented treatment of oblique crown-root fracture of a maxillary central tooth from enamel-cement junction by the reattachment technique. We used dual cured resin composite (Panavia F^®) and a self-tapping screw-post (Dentatus^®) for reattaching the crown fragment. Orthodontic treatment was applied for intruding and leveling the tooth. Four years after treatment, the tooth exhibited good esthetics, good periodontal health and normal function. However, minimal relapse occurred in spite of orthodontic treatment. In conclusion, the reattachment technique is an alternative method, which offers satisfactory esthetic and functional rehabilitation of the fractured teeth.     

Reattachment and orthodontic extrusion in the management of an incisor crown-root fracture: a case report

This article describes the management of a case of oblique crown root fracture of a central incisor where the fractured fragment was used as a temporary replacement crown in order to maintain esthetics during the period of orthodontic extrusion of the remaining root. Placement of the final restoration after orthodontic extrusion resulted in good esthetics and periodontal health postoperatively. The merits and demerits of this treatment modality are discussed.     

A conservative approach for the management of a crown-root fracture.

Subgingival crown-root fractures are major complications that jeopardize tooth survival and require the clinician to adopt a multidisciplinary approach combining different dental specialties to effectively treat the teeth and ensure long-term survival. Fragment reattachment is a conservative therapeutic option for uncomplicated crown-root fractures. However, biologic width involvement must be carefully evaluated and addressed. This article describes a case of restoration of a crown-root fracture by means of periodontal surgical exposure of the fracture, crown and root recontouring, and fragment reattachment.     

Alternative restorative approach: a clinical report.

This clinical report describes a technique for restoring a maxillary right posterior segment using a combination of a conventional full-coverage retainer and adhesive resin-bonded retainer with a nonrigid connection, periodontal ridge augmentation, and a coronal-radicular amalgam alloy core. A technique has been outlined that allows for the preservation of the maximum amount of natural tooth structure while restoring a maxillary right posterior segment.     

Full-mouth minimally invasive adhesive rehabilitation to treat severe dental erosion: a case report

Dental erosion is increasing, and only recently are clinicians starting to acknowledge the problem. A prospective clinical trial investigating which therapeutic approach must be undertaken to treat erosion and when is under way at the University of Geneva (Geneva Erosion Study). All patients affected by dental erosion who present with signs of dentin exposure are immediately treated using only adhesive techniques. In this article, the full-mouth adhesive rehabilitation of one of these patients affected by severe dental erosion (ACE class IV) is illustrated. By the end of the therapy, a very pleasing esthetic outcome had been achieved (esthetic success), all of the patient's teeth maintained their vitality, and the amount of tooth structure sacrificed to complete the adhesive full-mouth rehabilitation was negligible (biological success).     

Management of a complicated crown-root fracture using adhesive fragment reattachment and orthodontic extrusion

Abstract –  Dental trauma is more common in young patients and its sequelae may impair the establishment and accomplishment of an adequate treatment plan. This paper reports a case of complicated crown-root fracture in a young adult that was treated using adhesive tooth fragment reattachment and orthodontic root extrusion. Considering the time elapsed to follow up, the fracture extension, the amount of remaining root portion and the patient's low socioeconomic status, the treatment approach proposed for this case provided good functional and aesthetic outcomes. Clinical and radiographic results after 2 years were successful. This case report demonstrates the importance of establishing a multidisciplinary approach for a successful dental trauma management.     

Multiple crown-root fractures in primary molars and a suspected subcondylar fracture following trauma: a report of a case

Abstract –  Dental trauma is common and often more than one injury is found. Injuries to the primary dentition are usually luxations and mandibular fractures rarely occur. With trauma sustained to the chin, the posterior primary teeth are at increased risk of trauma and mandibular fractures can occur. The case discussed is of a 4-year-old female who presented 2 weeks following dental trauma with multiple primary molar fractures and a possible subcondylar fracture. The need for a detailed examination is emphasized and the management of the case under general anaesthesia is described.     

Reposition of intruded permanent incisor by a combination of surgical and orthodontic approach: a case report

This report presents a case of a completely intrusive luxation of an immature permanent central incisor in a 7 years 9 months-old girl. Because there are severe intrusive trauma and cortical alveolar bone fracture, it was impossible to reposition with orthodontic or surgical method alone. The intruded tooth was repositioned to healthy alveolar bone level by using surgical extrusion and stabilization with sutures and periodontal pack. After healing of adjacent bone, the intruded maxillary central incisor erupted orthodontically by removable orthodontic appliance. It was moved from a high position to level of adjacent tooth in about 7 months. A radiograph was taken 6 months after ceasing forced eruption, which demonstrated minor root resorption, but the alveolar bone height had increased.     

Treatment of a crown-root fracture with intentional replantation - case report with 16-year follow-up

AIM: To report the intentional replantation of a maxillary central incisor with a crown-root fracture. SUMMARY: An 11-year-old girl was referred to a paediatric clinic with an extensive crown-root fracture of the maxillary right central incisor (tooth 11) with pulp exposure. Radiographs revealed that tooth 11 had a periapical radiolucent lesion, which suggested pulpal necrosis. The treatment option chosen was planned extraction and immediate intentional replantation of tooth 11 in a more coronal position. Sixteen years after treatment, tooth 11 was aesthetically and functionally sound, suggesting that the treatment was successful. KEY LEARNING POINT: Intentional replantation may be considered as a treatment option for teeth with crown-root fractures.     

Extraoral extraction: a very rare surgical approach to tooth impaction. A case report

Extraoral route of access is usually not considered in surgical extraction of teeth because of technical difficulties and above all because of scar resulting from surgical skin wound healing. Some specific conditions, however, should suggest the use of this kind of access. A case of an impacted transmigrated right mandibular canine in an 18-year-old girl is reported. A CT examination has been carried out to evaluate the anatomy of the impacted toot as well as its relationship with the neighbouring structures. Extraoral surgical technique is then detaily described: skin incision, muscular dissection, ostectomy, tooth extraction and suture. Esthetical result was also reevaluated after 10 years. Advantages and drawbacks of intraoral and extraoral routes of access to mandibular tooth impaction are discussed and all anatomic and topographic factors related to the present impacted canine are examined. In conclusion, it is possible to confirm that extraoral access is indicated when a tooth is superficially impacted, in the molar-premolar region, toward the lingual aspect and near the lower border of the mandible.     

Frenulectomy: proposal of a new surgical approach and case report

The frenula of the oral cavity represent the insertion of perioral muscles in jaws, consisting of a fold of the triangular fibro-connective tissue covered with mucous membrane and usually inserted at the mucogingival line. The purpose of this work, after a review of literature, was to provide the clinical signs above the median frenum removal order for the orthodontic closure of a interincisor diastema and to present a new surgical technique.     

The orthodontic and restorative treatment of a large diastema: a case report

Treating diastemata in the anterior esthetic zone is a challenge; many factors must be considered when developing a treatment plan for such patients. This case report demonstrates how excellent results may be obtained using a multidisciplinary approach.     

The conservative treatment of pediatric mandibular fracture with prefabricated surgical splint: a case report

Abstract –  The use of rigid fixation in children is controversial and may cause growth retardation along cranial suture lines. Intermaxillary fixation for mandibular fractures should be used cautiously as bony ankylosis in the temporomandibular joint (TMJ) and trismus may develop. The high osteogenic potential of the pediatric mandible allows non-surgical management to be successful in younger patients with conservative approaches. In this case, successful conservative treatment of mandibular fracture of a 3-year-old patient is presented.