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CASE REPORT |
https://doi.org/10.5005/jp-journals-10047-0137 |
Comprehensive Management of Crown-root Fracture: A Case Series
1,2Department of Conservative Dentistry and Endodontics, The Tamilnadu Dr MGR Medical University, Chennai, Tamil Nadu, India
Corresponding Author: Vinitha Velusamy, Department of Conservative Dentistry and Endodontics, The Tamilnadu Dr MGR Medical University, Chennai, Tamil Nadu, India, Phone: +91 9080554482, e-mail: vinitha02121994@gmail.com
How to cite this article: Velusamy V, Kavitha M. Comprehensive Management of Crown-root Fracture: A Case Series. J Oper Dent Endod 2024;9(1):7–10.
Source of support: Nil
Conflict of interest: Dr Ritesh Kalaskar is associated as the Editor-in-chief of this journal and this manuscript was subjected to this journal’s standard review procedures, with this peer review handled independently of this editorial board member and her research group.
Patient consent statement: The author(s) have obtained written informed consent from the patient for publication of the case report details and related images.
Received on: 24 June 2024; Accepted on: 05 September 2024; Published on: 19 October 2024
ABSTRACT
The treatment options for trauma vary depending on the severity of the traumatic injury. A young patient suffering from such an injury might experience emotional trauma as a result of functional and esthetic causes. This case report describes the clinical management of two complicated crown-root fracture cases. A 23-year-old male patient came with a complaint of broken teeth in the upper front tooth region, with a history of road traffic accident (RTA). On intraoral examination, there was an Ellis class 3 fracture in 11, 12, and 21. So the diagnosis was made to be fractured teeth in 11,12, and 21. The patient has been treated with cast post in 11, fiber post placement and composite core buildup in 12, and 180° rotation in 21 and placement of metal-ceramic crowns in all three teeth. The patient has been followed up for a period of 1 year, and he is totally asymptomatic. A 17-year-old male patient came to the department with a missing tooth in relation to 22. IOPA has revealed the presence of root in 22, suggesting complete crown fracture in 22. So the treatment plan has been formulated to carry out surgical extrusion of 22 and restored with cast post and crown. Addressing the traumatic injury at the right time, with proper diagnosis and following a systematic approach might benefit the patient.
Keywords: Case report, Crown fracture, Dental trauma, Esthetic management.
INTRODUCTION
Traumatic dental injuries have been reported to be the fifth most prevalent disease experienced by people worldwide.1 The pooled prevalence of dental injuries in India has been reported to be 13%.2 The treatment options vary depending on the severity of the traumatic injury. The treatment of crown-root fracture might range from simple reattachment of the fractured fragment to pulp extirpation, as well as other means to extrude the tooth. However, a long-term evidence for successful reattachment of the fractured fragment is lacking.3 Any young patient suffering from such an injury might experience emotional trauma as a result of functional and esthetic causes.4
Thus, this case report aims to describe the clinical management of two cases with complicated crown-root fractures.
CASE DESCRIPTION
Case 1
A 23-year-old male patient came with a complaint of broken teeth in the upper front tooth region. On eliciting the history, the patient had met with a road traffic accident (RTA) and had maxillofacial trauma for which he has undergone Open reduction and internal fixation and reattachment of the upper front left tooth before 6 months and that has been lost during this period. On intraoral examination, there was class 3 fracture in 11, 12, and 21 (Ellis and Davey 1970). So the diagnosis was made to be fractured teeth in 11,12, and 21 (Fig. 1).
Fig. 1: Preoperative image showing loss of reattached fragment
A treatment plan has been formulated to carry out root canal treatment in 11,12, followed by 180° rotation in 21 with fiber post already in place in 21, cast post placement in 11, and fiber post placement in 12 with metal ceramic crown placement in 11, 12, and 21.
During the first appointment, root canal treatment has been carried out in 11 and 12.
Following this 21 is surgically extruded with 180° rotation and the teeth 13, 12, 11, 21, 22, and 23 are splinted with a semirigid type of splinting (23G SS wire and flowable composite) (Fig. 2). Fifteen days after the surgical extrusion, splinting is removed, and a wax pattern fabricated for cast post in 11. Cast post cemented with resin cement in 11 and fiber post cemented with resin cement in 12 and composite core buildup was done (Fig. 3). Metal ceramic crowns were cemented in 11, 12, and 21 (Fig. 4), and the patient has been scheduled for the follow-up at 3, 6, and 12 months when the tooth is clinically assessed for mobility, periodontal probing depth, and tenderness on percussion and radiographically for any abnormal periapical changes. No abnormality was detected during the 12-month follow-up (Figs 5 and 6).
Fig. 2: Surgical extrusion with 180° rotation and splinting
Fig. 3: Fibre post placement and composite core buildup in 12 and composite core buildup in 21.
Fig. 4: Metal ceramic crown in 11,12, and 21
Fig. 5: Twelfth-month follow-up
Figs 6A to C: Twelfth-month follow-up radiograph
Case 2
A 17-year-old male patient came to the department with a missing tooth in relation to 22 (Fig. 7). History revealed traumatic experience before 1 month. Clinically, tooth 22 was missing and intraoral periapical radiograph revealed the presence of root in 22 suggestive of complete crown fracture in 22. So the treatment plan was formulated to carry out surgical extrusion of 22 followed by cast post and crown placement in 22.
Fig. 7: Preoperative image
During the first appointment, the flap was elevated, and the root was extracted and splinted in an extruded position following 180° rotation. The tooth was then splinted with the semirigid type of splinting using 23G wire and flowable composite (Fig. 8). After 15 days, splinting was removed and root canal treatment was done in 22 with the impression made for cast post in (Fig. 9). Cast post cemented with glass ionomer cement (GIC) in 22 and temporary acrylic Jacket crowns were placed (Fig. 10) and a month after the temporary crown placement metal-ceramic crowns were cemented in 22. The patient has been followed up for 3 months and no abnormality has been detected clinically and radiographically (Figs 11 and 12).
Fig. 8: Surgical extrusion with 180° rotation and splinting of 22 with the adjacent teeth
Fig. 9: Cast post placement in composite core build-up in 21
Fig. 10: Temporary acrylic jacket crown placement following cast post-cementation in 22
Fig. 11: Third-month follow-up with metal-ceramic crown in place
Fig. 12: Intraoral periapical radiograph (IOPAR) at third-month follow-up
DISCUSSION
Crown fractures are the more common type of injury occurring in the permanent teeth. Proper diagnosis, treatment plan, and follow-up are important in achieving a favorable outcome.5
The restoration of the severely damaged tooth with inadequate clinical crown will pose challenges. In such a situation, an adequate biological width and the distance between the crown margin and the alveolar crest has to be ensured.6 To attain prosthetic rehabilitation, it is crucial to create an effective ferrule for a desirable biomechanical behavior of the tooth.7 The most common treatment options to achieve an adequate ferrule height include crown lengthening, orthodontic extrusion, and surgical extrusion.8 Surgical extrusion allows for rapidly achieving the desired crown length in a tooth with anatomy conducive for atraumatic extraction.7
The most common adverse effect of surgical extrusion is non-progressive root resorption however there is not much significant amount of progressive root resorption and marginal bone loss reported in the literature. Surgical extrusion when combined with 180° rotation can result in better restorative outcome without violating the biological width.9 Semirigid type of splint is considered ideal in case of the absence of bone fractures and the most commonly recommended materials for semirigid type of splinting are orthodontic wires or nylon and composites.10 Two-week splinting period has been chosen as it was considered to be the functional splinting time after surgical extrusion (Fig. 12).
Fiber post placement offers advantages owing to its rapid treatment outcome along with being an esthetically acceptable option, and they have less likeliness to cause irreparable root fractures.11 Cast post can take up the canal morphology and can be used in all types of canal configuration. It also allows for a slight change in the angulation for the correction of the proclined tooth.12
The 5-year survival rate of the single-unit crowns made of porcelain fused to metal has been found to be 83.2%.13–15
CONCLUSION
Thus, addressing the traumatic injury at the right time might benefit the patient in maintaining function and esthetics. These cases have been periodically followed up and there is no evidence of clinical abnormalities. Hence, the treatment procedures carried out in these cases might result in a long-term success.
ORCID
Vinitha Velusamy https://orcid.org/0000-0002-5322-3633
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