Complicated Crown-root Fracture Research Articles

Frequency and Patterns of Traumatic Dental Injuries Reported at Islamabad Dental Hospital: A Retrospective Study.

Background: Traumatic dental injuries (TDIs) are increasingly becoming a public health concern, with a significant number of cases presenting to emergency departments worldwide. They affect a diverse age range, particularly children and adolescents, and are influenced by various etiological factors such as falls, sports injuries, and road traffic accidents. Previous studies have indicated a gender predisposition, with males more frequently affected, and a pattern of injury that varies by region. Objective: This study aimed to investigate the frequency and patterns of TDIs treated at the Department of Operative Dentistry, Islamabad Dental Hospital, and to analyze the management strategies employed. Methods: A retrospective cross-sectional analysis was conducted, examining patient records from 2015 to 2022. Approval was obtained from the institutional review board, aligning with the Declaration of Helsinki. Data from complete TDIs forms were extracted, detailing the type of injury, timing, and treatment administered. Statistical analysis was performed using SPSS v.23, with chi-square tests applied to examine the association between the type of trauma and demographic variables. Results: A total of 88 teeth with TDIs were recorded. The most common injuries were complicated crown fractures (28.4%) and root fractures (17.0%), with splinting (31.8%) and root canal treatments (29.5%) being the most frequent management procedures. Male patients were predominantly affected. Notably, adult cases surpassed those of children and adolescents, contrary to global trends. Conclusion: TDIs constitute a significant portion of dental emergency cases, with specific patterns and treatments that vary by demographics. Immediate and appropriate management, guided by current guidelines, is essential. Efforts should focus on increasing awareness and providing adequate training to healthcare providers for timely and effective treatment of TDIs.

Management of Concomitant Intrusion and Complicated Crown-Root Fracture Injury of Maxillary Central Incisors in a Child

Dental intrusions are a severe type of injury because they impact the neurovascular supply of the tooth as well as the supporting tissues which predispose the tooth to necrosis and root resorption. Management of these injuries requires repositioning of the teeth under close monitoring to avoid complications. The management becomes more comprehensive when an intrusion is combined with other injuries, such as a crown-root fracture. This case report represents a 4-year follow-up of a child who suffered from a concomitant injury of intrusion and complicated crown-root fracture to the maxillary immature permanent central incisors. The management involved a multidisciplinary approach including endodontics, pedodontics, orthodontics, periodontics, and prosthodontics. Given the guidelines of dental trauma and the circumstances of the case, the fractured teeth were root canal treated, filled with a bioceramic plug and gutta-percha, and then restored with posts/cores and temporary crowns. The intrusion was managed initially by passive eruption followed by an active orthodontic eruption, after which the teeth were restored with permanent ceramic crowns. Throughout the course of treatment, the teeth showed no complications of root resorption or ankylosis, although one tooth developed a periapical infection which was managed by apical surgery. At the 4-year follow-up, the teeth revealed healthy periodontium and good esthetics.

Fragment reattachment in situ for complicated crown-root fracture in children permanent anterior: a case report

Fragment reattachment in situ for complicated crown-root fracture in children permanent anterior: a case report

Endodontic Treatment Outcome of 45 Incisor Teeth in Dogs Determined by Intraoral Radiography.

A retrospective study was conducted to determine the outcome of endodontic treatment of incisor teeth in dogs. Medical and dental records from four private veterinary specialty practices over an 8-year period (2013-2021) were reviewed. Forty-five incisor teeth from 41 dogs with ages from 1 to 11-years-old were included in the study. The indications for endodontic treatment were complicated crown fracture in 23 incisors (51.1%), non-vital tooth in 15 incisors (33.3%) and complicated crown-root fracture in seven incisors (15.5%). Evaluation criteria included availability of complete medical and dental records, patient demographics, and at least one follow-up visit as recent as 6 months after the initial root canal therapy. Endodontic treatment outcome was defined as successful, no evidence of failure, or failure. Root canal therapy was successful in 42 teeth (93.3%), no evidence of failure was found in three teeth (6.6%), and none of the cases showed failure of the treatment. Duration of follow-up ranged from 6 to 64 months. Only three variables appeared to have statistical significance: presence of preoperative periapical lucency (PAL) (P = .01), postoperative PAL (P < .001) and postoperative external inflammatory root resorption (P = .014). Based on this study, following "loose criteria" (success and no evidence of failure combined), 100% of the treatments were successful, making this option an excellent therapy choice in a veterinary specialty dentistry practice.

Critical appraisal of the 2020 IADT Guidelines: A personal commentary.

The 2020 International Association of Dental Traumatology (IADT) Guidelines feature several important changes in the treatment recommendations for traumatic dental injuries (TDIs) from the previous 2012 iteration of these Guidelines. This evidence-based narrative review aims to provide a detailed appraisal of five specific changes incorporated in the 2020 IADT Guidelines, based on the available literature evidence that may have prompted these changes. The paper discusses three excellent additions/changes to the new Guidelines: (i) inclusion of a core outcome set for reporting TDIs; (ii) more conservative management of primary dentition TDIs including the changed recommendations for radiation exposure and managing primary dentition luxation injuries; and (iii) the changes in the treatment recommendations for permanent dentition avulsion injuries. The paper further debates whether two other changes made in the current IADT Guidelines for-(i) intrusion injuries in immature teeth; and (ii) complicated crown-root fractures in mature teeth-have sufficient evidence to support the changed recommendations.

Research on the cone-beam CT of the fracture morphology and location of a single oblique complicated crown-root fracture of maxillary incisors

Objective: To study the morphological pattern of single oblique complex crown fracture and its relative location to periodontal hard tissues from a three-dimensional perspective by using cone-beam CT, which provides a more intuitive and comprehensive understanding for the pathological features and rules of single oblique complex crown fracture. Methods: Primary cone-beam CT images of 56 maxillary permanent anterior teeth with oblique complex crown root fractures were collected from the Department of Integrated Emergency Dental Care, Capital Medical University School of Stomatology during January 2015 to January 2019. Fracture pattern, fracture angle, fracture depth, fracture width, and the relative location of the fracture line to the crest of the adjacent alveolar ridge were retrospectively analyzed. Independent samples t-test was used to compare the differences in angle, depth and width of fractures between sexes and tooth locations, as well as the pre-and post-fracture crown-to-root ratios between different tooth locations. Then the affected teeth were divided into juvenile group (≤18 years), young group (19-34 years) and middle-aged and elderly group (≥35 years). One-way ANOVA was applied to compare the differences in angle, depth and width of fracture between age groups, and Fisher exact test to compare the differences in fracture pattern of the teeth and the relative position of the fracture line to the crest of the adjacent alveolar ridge. Results: There were 35 males and 21 females in 56 patients, aged (28.2±13.2) years. Among the 56 affected teeth, forty-six were maxillary central incisors and 10 were lateral incisors. According to the patients' age and growing stage, they could be divided into the juvenile group (19 cases), the young group (14 cases), and the middle-aged and elderly group (23 cases). Forty-six (82%) affected teeth had an S-shaped fracture pattern, and ten (18%) had a diagonal pattern, in which the fracture angle of the S-shaped fracture line (47.85°±10.02°) was significantly greater than that of the diagonal line (28.30°±8.07°) (P<0.001). The fracture nadir was flush with or below the top of the alveolar crest in 98% (55/56) of cases. The fracture depth was significantly greater in the juvenile group [(1.75±0.73) mm] than in the young group [(1.21±0.68) mm](P=0.042) and in the middle-aged and elderly group [(1.12±0.90) mm] (P=0.001). The width of fractures among 56 patients was (4.75±1.44) mm, which had no statistically significant differences between different age, sex and tooth location groups (P>0.05). There were no statistically significant differences in the crown-to-root ratios after fracture of maxillary central incisors (1.18±0.13) compared to maxillary lateral incisors (1.14±0.20) (t=1.90, P=0.373). Conclusions: The fracture patterns of single oblique complex crown fracture were mainly S-shaped and oblique alignment; the fracture nadir was mostly located within 2.0 mm below the palatal alveolar crest.

Epidemiological aspects of dental trauma associated with maxillofacial injures: Ten years of clinical experience in Trieste, Italy.

The prevalence of dental injuries in patients with facial fractures is relevant. Epidemiologically, dental trauma in association with facial fractures generally affects the age group between 20 and 40 years old, with a higher prevalence of males. The aim of this retrospective study was to identify the incidence and etiology of dental trauma associated with facial fractures over a ten years period. From January 2009 to April 2019, among 381 patients with facial fractures, 353 were included in this study. Age, gender, trauma etiology, injured teeth and dental treatment were investigated. From 353 patients, with a mean age of 49.7 ± 19.9 years, 247 (70%) were males and 106 (30%) were females. Accidental falls were the most common type of injury (n=118, 33.4%), followed by road accidents (n=90, 25.5%), assaults (n=60, 17%) and sports trauma (n=37, 10.5%). Fifty-five subjects (15.60%) had dental injuries associated with facial fractures. Of the 145 teeth involved, 48 (33,1%) were diagnosed with luxation, 22 teeth (15.2%) were avulsed, 11 teeth (7.5%) suffered concussion, and there were 10 (6,8%) alveolar wall fractures. Uncomplicated enamel-dentin fracture was the more frequent hard tissue injury (n=21, 14.5%), followed by complicated crown-root fracture (n=10, 6.9%), infraction (n=8, 5.5%), enamel fracture (n=3, 2%) and complicated enamel-dentin fracture (n=3, 2%). There was a peak in incidence between 21 and 40 years (42%). Males had a significantly higher risk of facial fractures with dental injury (75%). Maxillary incisors and canines (62.8%) were the most affected teeth. There was high prevalence of dental injuries associated with facial fractures. Maxillary incisors were the most injured teeth, with a higher prevalence in males.

Clinical Outcomes of Surgical Crown Reattachment as Treatment for Complicated Crown-Root Fractures: A Retrospective Study.

This retrospective study evaluated the clinical outcomes of surgical crown reattachment in the treatment of complicated crown-root fractures in permanent teeth in 35 patients. Treatments were defined as follows: surgical crown reattachment combined with internal fixation with a fiberreinforced core post, ostectomy, and reattachment of the original crown fragment. Patients were examined to record the periodontal pocket depth (PD), marginal bone loss, tooth migration, and coronal fragment looseness or loss. In most cases, the fracture lines on the palatal aspect were located below the alveolar crest. About 20% to 30% of teeth had periodontal pockets ≥ 3 mm present at least 1 year after surgery. Significant PD differences were observed between the traumatized teeth and adjacent untraumatized teeth at 6 months. The available evidence suggests that surgical crown reattachment is a feasible and effective technique for managing complicated crown-root fractures in permanent teeth.

Management of a Complicated Crown-root Fracture in Maxillary Anterior Teeth through a Multidisciplinary Approach

Abstract The treatment of dental traumas, particularly complicated crown-root fractures, can be intricate and necessitate a precise diagnostic and treatment plan. The optimal treatment strategy depends on factors such as the severity of the fracture, the tooth’s position, and the patient’s dental health. It is essential to consider the benefits and drawbacks of each option carefully and select the most appropriate treatment based on the patient’s individual needs and circumstances. Keeping in mind the best conservative approach, the chosen treatment for the current case, which involved a complicated fracture of the crown and root of a central incisor as seen in cone-beam computed tomography images, involved an orthodontic extrusion followed by placement of a permanent crown.

Multidisciplinary Approach in the Management of Maxillary Anterior Region Dental Trauma: A Case Report

Traumatic Dental Injuries (TDIs) to the maxillary anterior teeth occur frequently in paediatric and adolescent populations. Prompt diagnosis, correct treatment planning, and a multidisciplinary approach are pertinent aspects of successfully managing multiple TDIs in a patient. The present case report of a 13-year-old female patient describes a multidisciplinary approach necessary to successfully manage dental trauma of an avulsed maxillary central incisor and a complicated crown fracture involving the maxillary left lateral incisor in an adolescent. The complicated crown-root fracture was treated with endodontic therapy, followed by the placement of a fibrereinforced post, core build-up, and the cementing of a porcelain-fused-to-metal crown. Bone grafting with a mandibular symphysis block autograft, followed by prosthetic rehabilitation with transitional implants, was performed to restore the aesthetics, form, and function of the avulsed maxillary central incisors. The use of osseointegrated implants has gained wide acceptance in the adult population. However, due to concerns regarding growth, their use in the paediatric population is not as common. This accounts for a scarcity of clinical cases reported in the literature. There are no established guidelines for the placement of implants in growing patients. Thus, authors believe that the present case report contributes to the literature on this subject. The treatment of this complex, multi-dental injury in the maxillary anterior region of a young female required a holistic approach with a step-wise progressive, long-term treatment plan. Traumatic injuries in adolescent patients can adversely impact their oral health-related quality of life if not treated correctly.

Multidisciplinary Treatment Approach for Complicated Crown-Root Fracture w.r.t 11

Dental trauma causing crown-root fracture is among utmost challenging types of dental traumas in terms of management, which often involves maxillary permanent incisors prior to completion of their root development and can result in tooth loss The goal of this case was to give a clinical example of rehabilitation of a complex crown-root fracture of the right maxillary central incisor that was treated successfully using a multidisciplinary approach that also included surgical crown lengthening. In the follow-ups, the final result was aesthetically pleasing and periodontally sound.

Reattachment of coronal tooth fragments: Aesthetic management of a complicated anterior maxillary crown fracture

Abstract The trauma of anterior teeth is a frequent occurrence in young patients. Reattachment of fractured fragments is one of the various treatment modalities proposed in anterior tooth coronal fractures. The reattachment of fractured fragments grants the advantage of immediate aesthetic rehabilitation and restoration of function, which is a relatively rapid and less arduous procedure. The manuscript presents a case report depicting the management of a complicated crown root fracture of anterior maxillary teeth first treated endodontically, followed by reattachment of the same fragment with a cast post-reinforcement. Reattachment of fractured coronal tooth fragments is a feasible restorative option, rapidly restoring the function and aesthetics of the tooth by a conservative and inexpensive approach.

Direct fragment reattachment of a complicated crown root fracture of maxillary lateral incisor: A case report

Direct fragment reattachment of a complicated crown root fracture of maxillary lateral incisor: A case report

A A Holistic Approach of Rehabilitating Maxillary Central Incisors with Complicated Crown Root Fracture - A Case Report

Traumatic injury to anterior teeth is frequent in children and adolescents owing to an active lifestyle. Proclined maxillary incisors are more prone to fracture due to their location in the oral cavity. Complicated crown root fractures present endodontic, restorative and aesthetic challenge and requires a multidisciplinary treatment approach to achieve predictable success. This case report describes, multidisciplinary management of such complicated crown root fractures following traumatic injury.&#x0D;

Endo-Aesthetic rehabilitation of complicated crown-root fracture of maxillary lateral incisor by fragment reattachment: A case report

In case of traumatic injuries to the anterior teeth, fragment reattachment is considered a minimally invasive technique. Re-attaching the same tooth fragment, possesses the advantage, of biomimicry by complete restoration of form, function, texture, lustre, and translucency. Due to advancements in adhesive dentistry, simple re-attachment to complex fragment rehabilitation have become predictable and reliable. Various techniques have been proposed for fragment reattachment based on the extent of injury, type of injury, condition of the fragment, and time- lapse. This case report demonstrates the endo-aesthetic rehabilitation of a complicated crown root fracture using a fiber post on lateral incisor with fracture line on the cervical 1/3of the labial aspect, running obliquely and apically towards the palatal surface after 1 year follow-up.

Conservative approach for managing complicated crown-root fracture in a 4-year-old child: A case with 12-month follow-up

Traumatic dental injuries (TDIs) are of great concern when it comes to a child. Crown-root fracture is the most complicated type as both crown and root are affected by trauma. Complicated crown-root fracture seldom occurs in deciduous dentition. It is a tragic experience and requires immediate attention and quick functional and esthetic repair. Appropriate and early diagnosis leads to successful treatment, for which knowledge on types of TDIs, classification, and management is necessary. Complete restoration of teeth affected with trauma will restore function and esthetics and preserve occlusal harmony. The objective of the present case report is to discuss the appropriate diagnosis and conservative treatment of this unusual and rare case of complicated crown-root fracture in a 4-year-old child using tooth fragment reattachment. This case will focus on the options to restore the uncommon trauma and normalize the function and esthetics of the patient, which will lead to improvement of speech, increase in self-confidence and protection of successors, and describe the treatment and aspects concerning follow-up of the patient.

Crown root fracture imaging on Cone Beam Computed Tomography

Objectives: This case report is aimed to describe the features of CBCT in assessing tooth fracture.&#x0D; Case Report: A 50-year-old man came with complaints of discomfort in the right lower jaw area, especially when used for chewing. The results of the percussion test were positive. CBCT examination showed that there was a radiolucent image of the enamel in the middle of the crown root to the 1/3 apical of the mesial and distal roots of tooth 47 which resembled a fracture line. The fracture line also appears to have reached the pulp. In addition, there is a well-defined radiolucent appearance with an irregular shape along the root from the buccal to lingual alveolar crest and accompanied by a decrease in the alveolar crest. The fracture that occurred in this case was from the enamel to the apical and involved the pulp, thus the radiodiagnosis on tooth 47 was a complicated crown root fracture with lateral periodontal cyst.&#x0D; Conclusion: CBCT can be used to help identify tooth fractures by obtaining a more accurate and useful value in differentiating conditions associated with fractures. CBCT provides data on the size and length of the fracture line and the size of the lesion.

Management of fracture in a tooth with previous history of fracture and fragment reattachment - An unexpected complication

Dental trauma duringthe young age will certainly affect the overall dental occlusal equilibrium. Complicated crown root fractures are difficult to manage as they are technique sensitive and demand patient’s compliance towards the maintenance throughout the treat-ment. Failure of maintenance will lead to treatment failure making the tooth to be indicated for extraction. This is a case of complicated crown root fracture where a 10-year-old child failed to take care of a stabilised tooth leading to fracture of crown en mass. The tooth was later indicated for root submergence procedure followed by removable partial denture as prosthetic replacement. Key Words Apexogenesis, Crown en Mass Fracture, Crown Root Fracture, Immature Tooth, Root Submergence

Management of complicated crown root fracture using pizeo surgery, fiber post and fragment reattachment: A case report

A common type of fracture involving tooth is complicated crown root fracture of anterior teeth. The reattachment of the coronal fragment to the remaining tooth will provide better and long-lasting aesthetics, improved function and a positive psychological reaction. It is a simple and less difficult procedure if the original tooth fragments are retained after fracture. This paper reports about a case of complicated crown root fracture that was treated successfully using broken fragment adhesive reattachment and post placement.

Oral and Dental Examinations Findings in 15 Zoo Bolivian Squirrel Monkeys (Saimiri boliviensis) and Black-Tufted Marmosets (Callithrix penicillata).

As part of an annual wellness evaluation, we performed oral and dental examination under general anesthesia in 7 zoo Bolivian squirrel monkeys aged 10 and 15 years, and 8 zoo black-tufted marmosets aged between 1 and 7 years. No oral discomfort was observed in any animal prior to the procedure. Apart from dilacerated roots of second mandibular incisor teeth in Bolivian squirrel monkeys and one case of presumably odontodysplasia in a black-tufted marmoset, no major variations in number and shape of the present teeth and roots were revealed. All 15 animals had gingivitis, but periodontitis was only diagnosed in 3 black-tufted marmosets. Most commonly diagnosed dental pathology in Bolivian squirrel monkeys was attrition/abrasion, affecting 11.9% of all teeth, followed by caries, which was only diagnosed in older animals. Altogether 8 fractured teeth were diagnosed in Bolivian squirrel monkeys only, with root fracture being the most common type, followed by complicated crown fracture and complicated crown-root fracture. Radiographic signs of endodontic disease were found in 10 teeth in Bolivian squirrel monkeys and in one nonvital tooth with intact crown in a black-tufted marmoset. We associated high occurrence of caries in the older Bolivian squirrel monkeys with their diet and saliva characteristics of these animals. Lack of any periodontitis in Bolivian squirrel monkeys may partially be attributed to limitations of radiography technique, although squirrel monkeys appear to be far less susceptible to naturally occurring periodontitis than marmosets.