Complicated Crown-root Fracture Research Articles

Smile Reestablished—Predictable Management of Complicated Crown-root Fracture through Surgical Extrusion with and without 180° Rotation: A Case Report

Smile Reestablished—Predictable Management of Complicated Crown-root Fracture through Surgical Extrusion with and without 180° Rotation: A Case Report

Single- versus multi-visit approach for fragment reattachment in complicated crown-root fractures: a cohort study

BackgroundComplicated crown-root fractures are a type of tooth fracture that involves the enamel, dentin, and cementum and accompanied by pulp exposure. The treatment of a complicated crown-root fracture is always challenging due to the difficulties in achieving a hermetic seal and a stable restoration with a fracture level close to the crestale bone level. This study aimed to evaluate and compare the efficacy of single-visit and multi-visit approaches for fragment reattachment in complicated crown-root fractures of anterior teeth.MethodsTwo cohort consist of 10 adolescent patients in each group at both genders, who suffered from permanent anterior tooth complicated crown-root fracture were included. Fragment reattachment with root canal treatment was performed with either single or multiple-visit approach. Single visit fragment attachement combined with root cannel therapy was conducted in single-visit approach group immediately after injury. Fragment attachment, root cananel therapy and post resoration were performed during three times ‘ clinical visit in multi-visit approach group.ResultsAll the patients in both groups achieved satisfactory aesthetic results one year after fragment reattachment. Patients who underwent a multi-visit approach had a significantly shorter operative duration, less intra-operative pain and fatigue, slightly better periodontal health at an early stage, and a decreased incidence of temporomandibular joint disorders compared to those who underwent a single-visit approach. However, multiple visits approach may increase the risk of fragment detachment postoperatively.ConclusionFragment reattachment a reliable but temporary technique for adolescent patients who have suffered from complicated crown-root fractures. Multi-visit approach showed similar effecacy to single-visit approach but with slightly less complications. The choose of these two merhos should depend on the specific patient situation and patient compliance.Trial registrationThis prospective cohort study was retrospectively registered in Chinese Clinical Trial Registry (ChiCTR2300076811) on 19/10/2023.

Fragment Reattachment For Complicated Crown Root Fracture – A Case Report

Complicated crown-root fractures are challenging dental injuries that involve both enamel and dentin structures and extend into the root. They often necessitate a multifaceted approach to achieve successful reattachment and functional restoration. This case report describes the management and outcomes of a complicated crown-root fracture using a reattachment technique

Management of complicated crown fracture in maxillary incisor using fragment reattachment - 5-year follow-up

Complicated crown-root fractures of maxillary incisors are a relatively common occurrence in cases of trauma to the facial region. Patients with such fractures are in acute pain and usually require emergency care on their first clinical visit. Pain management and restoration of function, esthetics, and phonetics should be the prime objective in handling such patients. The reattachment of fractured tooth fragments is a relatively simple procedure that provides natural esthetics and conservation of tooth structure. This case report describes such a reattachment procedure in a complicated crown-root fracture and its success at 5 years of follow-up.

Management of Complicated Crown Root Fracture Using Chamfer Reattachment Technique

Abstract The reattachment of the tooth fragment is one of the viable treatment options if the original intact tooth fragment is available following dental trauma. The reattachment of the remaining fractured tooth can provide better aesthetics, improved function and generate a positive psychological response amongst patients. This case report consists of three cases of crown root fracture that was successfully treated using tooth fragment reattachment technique.

Management of complicated crown-root fracture in a paediatric patient: A case report

Management of complicated crown-root fracture in a paediatric patient: A case report

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.

Repairing the Irredeemable Fragment Reattachment of a Complicated Crown-root Fracture with Fiber Post

Coronal fracture of the anterior teeth is a commonly occurring dental trauma often seen in young individuals. Such fractures can be conservatively managed with fragment reattachment procedure when the fragment is available and preserved in correct storage media. Due to advancements in adhesive dentistry, fragment reattachment is a simple, esthetic and fast treatment option. This article reports a case of fragment reattachment of a complicated crown root fracture using fibre post as an intraradicular splint.

Reattachment of Fractured Maxillary Central Incisor with Fibre Post

Abstract Traumatic dental injuries leave dental practitioners with severe therapeutic problems. Traumatic dental injuries with a prevalence of 25% among school children and 33% among adults are a public health problem that can have a negative influence on the quality of life. In cases of trauma to the facial region, the incidence of maxillary central incisors is 37%, followed by that of lateral incisors (16%). Traumatic injuries to teeth can be uncomplicated crown or crown-root fractures or complicated crown or crown-root fractures. Various treatment options may be employed for the management of complicated crown-root fractures of teeth. The reattachment of tooth fragments has been a preferable alternative to the restoration of the tooth. Reattachment provides a better aesthetic result in less time, i.e. regarding the original tooth shape colour texture translucency and occlusal contacts which is both very satisfying for the patient as well as the practitioner. The purpose of this case report is to evaluate the long-term prognosis of a maxillary central incisor with complicated crown-root fracture managed by reattachment of the fragment with fibre post.

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.