Complicated Crown-root Fracture Research Articles

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.

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.
 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.
 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.

Biologic restoration: A successful treatment option for immediate esthetics – A case report

Crown fractures mainly in the anterior region are the most common outcome of traumatic injuries. The common cause is ascribed to falls, motor vehicle accidents, and contact sports. Out of all the dental trauma injuries, dentoalveolar trauma contributes to about 25%, which may vary from simple crown fracture of enamel and/or dentin to complicated crown root fractures. In this case report, an undergraduate dental student reported with a fractured crown due to a fall an hour earlier. The clinical and radiographic assessment leads to the diagnosis of an uncomplicated crown fracture. Fracture line was extending obliquely till the middle third of the crown involving enamel and dentin. Tooth segment adaptation was evaluated, and decision was made to attempt for reattachment procedure. The tooth was isolated using rubber dam and tooth fragment was reattached using flowable composite. Follow up period was noted for 6 months. Tooth segment reattachment is a minimally invasive procedure with immediate aesthetic and it is not time consuming. This procedure has a predicable long-term prognosis with minimal complication due to advances in adhesive technique. Various factors should be taken into consideration for maximizing the benefits. Thus, this simple procedure is an alternative to the other complex restorative procedure for restoring tooth function, form, and esthetics. Recent advances in flowable composites can be used for a much more predictable result pertaining to strength and aesthetics.

English

Complex crown root fracture has been reported to be 5 % among the traumatic injuries to permanent teeth. In children, when fracture line extended sub gingivally, the treatment option remained was the extraction of tooth. This extraction led to alveolar bone loss and compromised the outcome of final prosthesis. Root submergence is one of the treatments options which can prevent bone loss and prepare future pontic site in a better way. In children, this technique can prevent not only bone loss but also the occurrence of space loss and development of tongue thrusting habit. Crown-root fracture is defined as a fracture involving enamel, dentin and cementum. It is reported in about 5 % of dental trauma to young children where root completion has not occurred.1 Treatment of these complex tooth fractures in aesthetic zone in growing age is always challenging for the paedodontists. The treatment should not interfere with the growth and development. Depending upon the extension of the fracture line which can result in exposure of the pulpal tissue, the crown-root fracture can be divided into two groups: complicated and uncomplicated. 2 Treatment options in cases of complicated crownroot fractures are complex, and require a multidisciplinary approach. Dental traumatology guideline and American Academy of Paediatric Dentistry has suggested fragment reattachment, orthodontic or surgical extrusion of apical portion followed by post placement, root submergence and extraction. 3 Factors like extension and direction of fracture line, pulpal involvement, tooth maturity and the length of root remaining in the alveolus govern the treatment choice. 4,5 Among above mentioned factors, position of facture line is the most important. As in case of subgingival facture line, risk of bacterial contamination is present and further this may result in gingival inflammation.6 When crown root fracture to permanent tooth occurs in mixed dentition period, goals of treatment are to preserve the tooth in arch without disturbing the growth & development of root and arch. But in case of complicated crown root fracture, when extraction is the only choice of treatment, future complications like space loss, crowding, habits like tongue thrusting and importantly loss of alveolar bone height should be kept in mind. Goals of treatment plan in such cases should be elimination of space loss, development of deleterious habit and maintenance of alveolar ridge for future pontic or implant site. Root submergence is the technique with which we can achieve these goals, keeping this in mind this case was planned and reported.

English

Restoration of traumatic teeth with complicated crown root fracture poses many challenges to the clinicians. When the fracture line is below the level of gingiva, the prognosis of such fractured tooth is considered questionable or hopeless. Treating such cases is also challenging as they are associated with loss of ferrule and compromised biological width. Preservation of such diseased natural teeth usually involves a multi-disciplinary approach involving endodontic therapy, periodontal crown lengthening and / or orthodontic extrusion followed by prosthetic rehabilitation. Tooth injuries and complicated tooth fractures especially in the aesthetic region pose a great challenge to the clinician.1 When the fracture line extends at or below the level of cement enamel junction, the prognosis of such tooth is considered questionable or hopeless; they are usually associated with the loss of ferrule and compromised biological width, and therefore restoration of such teeth becomes a great challenge. To ensure functional longevity, endodontically treated teeth with less coronal structure must have at least 5 mm of tooth structure coronal to the crestal bone. Three milli meters of tooth structure is needed to maintain a healthy soft tissue complex, and 2 mm of coronal tooth structure incisal to the preparation finish line is necessary to ensure structural integrity.2 There are mainly two reasons why a tooth extraction should be avoided: Structural reasons and psychological stress associated with extraction. Psychological stress can be in the form of financial stresses associated with extraction and rehabilitation of the same and fear of post-traumatic pain. Extraction of tooth is also followed by aesthetic challenges as it may lead to hard and soft tissue resorption as the healing architecture is unpredictable. In this case report a simple yet effective treatment is presented for a 21-year-old female patient with a chief complaint of clinical tooth fracture in relation to 44. After thorough clinical and radiographic examination, it was decided to reinforce the use of flexible glass fibre post and incorporate the same as tags to engage E chain to facilitate orthodontic tooth extrusion followed by prosthetic rehabilitation. The purpose of this case report is to describe the use of a simple chair side technique for a tooth fractured at the level of cementoenamel junction (CEJ) with forced tooth eruption.

A cross-sectional evaluation of knowledge among Chinese dentists regarding the treatment of traumatic injuries in primary teeth.

Injuries to the primary dentition affect children's esthetics, function, and mental health. They may also affect the development of the permanent teeth. The knowledge of dentists about deciduous tooth trauma is rarely evaluated. The aim of this study was to evaluate the knowledge and attitude of dentists in China regarding traumatic dental injuries to primary teeth. A self-administered online questionnaire containing questions on demographic data and knowledge based on a clinical scenario was given to a purposive sample of dentists, recruited by a non-probability convenience sampling method. The chi-square test was used for statistical analysis, with the significance level set at P <.05. A total of 394 out of 409 dentists provided valid data. There was no significant difference in demographic data. Questions about the treatment of hard dental tissue injuries in primary teeth presented a correct-response rate of 66.4%, with the highest correct-response rate for enamel fracture (n=368, 93.4%) and lowest for complicated crown-root fracture with pulp exposure (n=104, 26.4%). Questions about treatment of luxation injuries in primary teeth presented a correct-response rate of 66.6%, with subluxation presenting the highest correct-response rate (n=391, 99.2%). Factors associated with higher correct-response rates were specialist disciplines, educational qualifications, workplaces, experience of injured teeth treated, and educational experience about primary tooth trauma. No significant differences were found in the correct-response rates of dentists with different years of work experience. Lack of cooperation from children was considered a major obstacle for treatment. Special lectures and Internet courses were the most preferred methods of obtaining knowledge. The results suggest that it is necessary to enhance dental trauma education for dentists in China. More attention needs to be paid to trauma in primary dentition to ensure adequate treatment for traumatized primary teeth.

Prevalence of Traumatic Dental Injury in a Tertiary Care Hospital: A Descriptive Cross-sectional Study.

Traumatic dental injury is an injury inflicted on the dentoalveolar system. It has a physical as well as a psychological impact. Despite this concern, epidemiological data regarding its prevalence is insufficient in the literature of Nepal. Hence, this study's objective was to investigate the prevalence of traumatic dental injuries for the patients visiting Universal College of Medical Sciences, Bhairahawa, Nepal, over five years. A descriptive cross-sectional study was conducted using records from the medical record section for the patients presenting at the dental emergency outpatient department of the Universal College of Medical Sciences, Bhairahawa, Nepal, between April 2014 and April 2019. Ethical approval was taken from the Institutional Review Committee of the Universal College of Medical Sciences. Patient demographic data, type of traumatic dental injuries, and etiologies were evaluated from the record section. Out of 10,080 patients registered during the study period, 793 patients (7.86%) were due to traumatic dental injury, out of which 628 (79.2%) were male, and 165 (20.8%) were female. The most vulnerable age group was 20-29 years (42.4%). Most frequently, injuries occurred in June (16%). Road traffic accidents (57.8 %) were the most common mode, and complicated crown-root fracture (23.3%) was the most common type of traumatic dental injury. The frequency of 7.86% of traumatic dental injury indicates that dental traumatology needs special attention for policy planning and professional training.

KOMPLİKE KRON KÖK KIRIĞININ RESTORE EDİLMESİNDE YENİ BİR YAKLAŞIM

Amaç: Bu olgu sunumu, travma sonucu servikal bölgeden kırılmış maksiller kesici dişe, fiber post-kor yapımını ve kırık parçanın modifiye reataçman tekniği ile uyumlandırılarak yapılan tedavi prosedürünü anlatmaktadır. Olgu Sunumu: Otuz iki yaşındaki kadın hasta maksiller orta keser dişinde 2 ay önce travma sonucu oluşan kırık şikayeti ile kliniğimize başvurdu. Hastanın herhangi bir sistemik probleminin bulunmadığı saptandı. Klinik ve radyografik muayenede maksiller orta keser dişin servikal bölgeden kırıldığı, kırılan koronal parçanın da kaybolduğu belirlendi. Kök kanalı %5,25 NaOCl ile irrige edilerek, NiTi döner eğe sistemi ile genişletildi. Daha sonra güta-perka ve kök kanal patı ile dolduruldu. Hasta, protetik diş tedavisi bölümüne yönlendirildi. Hasta randevusunu beklerken, kayıp diş parçasını evde buldu ve tekrar kliniğimize başvurdu. Öncelikle santral dişe, fiber post-kor uygulaması yapıldı. Kırık parçanın iç yüzeyi kor yapıya uyumlandırıldı ve kırık parça, dual cure rezin siman kullanılarak yapıştırıldı. Yapılan klinik ve radyografik muayenede ilgili dişte herhangi bir semptom gözlenmediği ve periapikal dokuların sağlıklı olduğu belirlendi. Sonuç: Komplike kron kök kırığı olan bir dişte, reataçman tekniğiyle hastanın kronunun fiber post-kor yapıya uyumlandırılması, alternatif bir tedavi yöntemidir. Anahtar sözcükler: Komplike Kron Kök Kırığı, Travma, Reataçman Tekniği, Endodonti, Restorasyon A New Approach for the Restoration of Complicated Crown Root Fracture ABSTRACT Aim: This case report describes the treatment procedure of a traumatized maxillary incisor tooth with a cervical fracture adapted a fiber post-core and modified reattachment technique. Case Report: A 32-year-old female patient applied to our clinic with a fractured central incisor due to a previous trauma that occurred 2 months prior. The patient’s medical history was non-contributory. A clinical and radiographic examination revealed horizontal crown fractures in the cervical of the crowns of maxillary incisors. The refracted coronal fragment was detected that was disappeared. Under copious irrigation with 5.25% NaOCl, the teeth were instrumented with NiTi rotary instruments. Root canals were obturated with gutta-percha and sealer. The patient was referred to the prosthetic dental treatment department. While the patient was waiting for her appointment, she found the missing fragment at home and returned to our clinic. Afterwards, the tooth was restorated with fiber post-core. The refracted coronal fragment’s internal surface was adapted to the core. The fragment was bonded using a dual cure composite resin cement. A clinical and radiographic examination revealed that the tooth was not observed symptomatic condition and had healthy periapical structures. Conclusion: The patient crown fragment adjusted to post-core structure with reattachment of a tooth with cervical crown fracture is an alternative treatment method. Key words: Complicated Crown Root Fracture, Trauma, Reattachment Technique, Endodontics, Restoration

The treatment strategy of an oblique complicated crown-root fracture: A case report

A crown-root fracture is defined as a fracture which involve enamel; dentin and root cementum with or without the involvement of pulp. If pulp is involved it is known as complicated crown-root fracture. It is usually oblique in nature involving both crown and root. In this case report we have a case of 20 year old female with oblique complicated crown-root fracture and an irreversible pulpitis of maxillary left canine. In this case endodontic therapy followed by reattachment of fractured fragment with a prefabricated fiber post followed by PFM crown was the treatment plan for the patient and patient responded successfully to treatment..

Fragment reattachment after complicated crown-root fractures of anterior teeth: A systematic review.

Fragment reattachment is a procedure that can immediately restore form and function in crown-root fracture cases and is considered a minimally invasive and cost-effective treatment option. The aim of this systematic review was to analyze the methods used and the outcome of fragment reattachment for complicated crown-root fractures of anterior teeth. Five electronic databases (PubMed, Web of Science, Embase, Scopus, and Google Scholar) were searched for English language articles regarding fragment reattachment after complicated crown-root fractures of anterior teeth. Twelve case reports and two case series were selected for this review after applying the inclusion and exclusion criteria. In eleven articles, the fracture line was exposed prior to reattachment. Root canal treatment was performed in all cases except one, where conservative pulp treatment was done prior to reattachment. A post was used as part of the restoration in 85% of the cases. Additional fragment preparation was done in 42% of the cases in the form of beveling and groove formation. Adhesive strategies used to reattach the coronal fragments were total-etch, self-etch, or self-cure adhesive. Intermediate materials used for reattachment were resin cement, glass-ionomer cement, composite and self-adhesive cement. Treatment outcomes were favorable in all the included articles and the follow-up period ranged from three months to seven years. Fragment reattachment after complicated crown-root fractures of anterior teeth can be considered as a viable treatment option if the clinical conditions are favorable.

Management Of Complicated Crown-Root Fracture By Surgical 180-Degree Rotation: Case Report With One Year Follow-Up

Management Of Complicated Crown-Root Fracture By Surgical 180-Degree Rotation: Case Report With One Year Follow-Up

The effect of partial pulpotomy with iRoot BP Plus in traumatized immature permanent teeth: A randomized prospective controlled trial

A new bioceramic material iRoot BP Plus has been introduced and reported to have good biocompatibility, sealing ability and antibacterial activity. It has also been reported to be successfully used for procedures such as pulpotomy, pulp floor perforation repair and so on. However, there are only a few reports on the use of iRoot BP Plus in the management of traumatised teeth with an exposed pulp. The aim of this study was to investigate the clinical and radiographic outcomes of partial pulpotomy with iRoot BP Plus in immature permanent teeth with complicated crown fracture or complicated crown-root fracture. The study was prospectively designed and 110 immature permanent teeth with complicated crown fracture or complicated crown-root fracture were randomly allocated into two groups (n = 55). All teeth were clinically and radiographically assessed at 1, 3, 6, 12, 18 and 24 months after partial pulpotomy with iRoot BP Plus (experimental group, n=50) or calcium hydroxide (control group,n=49) as the pulp capping agent. Eleven cases were lost during follow-up, and 99 teeth were finally analysed. There were no intergroup differences in the survival rate, survival time, root length and dentin wall thickness. The calcific bridge was significantly thinner in the iRoot BP Plus group than in the calcium hydroxide group (0.97±0.13mm vs. 1.36±0.12mm; F=5.128, P=0.029). iRoot BP Plus may be an effective capping material for partial pulpotomy.

Conservative treatment of traumatic crown fracture extending into cementum by glass post aided adhesive bonding of autogenous tooth fragment: A report of two cases

Advancement in the adhesive system has made fragment reattachment a viable treatment option for treating tooth fractures. It offers a simple and conservative technique to restore esthetics and function. Reattachment of a completely disjointed crown may need additional fiber post retention due to the greater functional load borne by the fragment. This article reports two cases of complicated crown root fracture managed by utilizing fiber post to reattach the disjointed crown fragment. The reattached fragment has shown reliable retentivity and periodontal health at 1-year follow-up.

Dental trauma: management of complicated crown root fractures

Trauma of maxillary incisors is frequent and dental practitioners have to be competent in managing the consequences. Complicated crown root fractures of anterior teeth can have profound aesthetic and psychological implications on patients. In younger patients, if extractions are considered, it can lead to complex prosthodontic challenges in the future. Ideally, an attempt should be made in restoring the traumatized teeth, so an effective aesthetic and functional result can be reached. This case report highlights the treatment of complicated crown root fractures on maxillary incisors using endodontics and fragment re-attachment of the fractured crowns. Twelve-month follow-up of the treatment demonstrated aesthetic and functional success and delayed the need for prosthetic replacement. CPD/Clinical Relevance: This paper describes traumatic injuries of teeth and how management via fragment re-attachment of the fractured crowns has led to delay of definitive prosthetic treatment.