Treatment Of Crown Fracture Research Articles

Treatment outcomes after uncomplicated and complicated crown fractures in permanent teeth

ObjectivesThe objectives of this retrospective clinical study were to describe characteristics of crown fractures in permanent teeth and to investigate the survival of pulp vitality and restorations in uncomplicated and complicated crown fractures.Materials and methodsThis retrospective study collected information from patients suffering from dental trauma who were treated between January 2004 and June 2017. The study population consisted of 434 patients (253 males/181 females; mean age 20.7 years) with 489 uncomplicated and 127 complicated crown fractures. The Kaplan-Meier survival curves and Cox proportional hazard regression analyses were performed to explore the data statistically.ResultsThe mean observation time was 522 days. Uncomplicated crown fractures without luxation showed a higher success rate of 82.3% (345/419) than complicated crown fractures without luxation (72.3%, 73/101). An additional luxation in uncomplicated crown fractures resulted in significantly reduced success rates in terms of survival of the pulp and restoration. Direct restorations survived significantly better independent of the fracture mode than did adhesively reattached crown fragments. No superiority of mineral trioxide aggregate or calcium hydroxide as pulp capping agent in complicated crown fractures was documented. Approximately 85.5% of all complications occurred within 2 years after the accident.ConclusionThe treatment of crown fractures resulted mostly in successful outcomes and only a moderate number of complications were observed.Clinical relevancePrimary dental management of crown fractures should follow recently published clinical guidelines, and close monitoring over at least 2 years seems to be justified.

Forced orthodontic extrusion for anterior traumatized teeth by a simplistic approach

The management of patients with traumatic injuries to their dentition is an integral part of the general dental practice. Anterior teeth with fractures that extend subgingivally require a complex treatment plan that addresses biologic, esthetic, and functional factors, such as mastication and speech. Treatment of crown fractures often requires a multi-disciplinary approach. However, crown-root fractures with fracture line below the gingival attachment or alveolar bone crest present restorative difficulties. This case report presents a 24-year-old male who reported with fractured upper right lateral and central incisors and upper left central incisor following road traffic accident. On clinical examination, it was observed that the upper right lateral incisor had a horizontal fracture at the cervical one-third level with the fracture line extending subgingivally, mid crown fracture of right central incisor and incisal fracture of left central incisor. All the traumatized teeth were first treated endodontically, and then referred to our department for orthodontic extrusion before permanent crown placement.

Treatment of crown-root fracture with a modified crown fragment reattachment technique

The development of adhesive dentistry has allowed that the crown fragment reattachment can be another option in the treatment of crown fracture. However, additional crown lengthening procedure or extrusion of the tooth may be necessary in the treatment of crown root fracture because subgingival fracture line in close proximity to the alveolar bone leads to challenges for restorative procedure and the violation of the biologic width. This case report presents a modified crown fragment reattachment technique of crown root fracture with pulp exposure, which was done without additional crown lengthening procedures. After the endodontic treatment, the patient was treated using a post insertion and the fragment reattachment technique, which made it possible to preserve the space for the biologic width and maintain a dry surgical field for adequate adhesion through the modification of the fractured coronal fragment. Since a coronal fracture was occurred and reattached afterward, it was observed that the coronal fragment was well maintained without the additional loss of periodontal attachment through 2-year follow up.

Multidisciplinary approach to traumatized teeth: a case report

Treatment of crown fractures often requires a multidisciplinary approach. In the anterior teeth, reestablishment of proper esthetics and function is quite important for the patient. However, crown-root fractures with fracture line below the gingival attachment or alveolar bone crest presents restorative difficulties. This case report presents a cervical tooth fracture that had been treated with minimal invasive approach with different disciplines. The tooth had endodontic treatment and a glass-fiber post, and a composite core was accomplished. Then, the tooth was extruded to the desired level with orthodontic forced eruption before definitive restoration.

Adhesive fragment reattachment after orthodontic extrusion: a case report

In the treatment of crown fractures, adhesive fragment reattachment provides a good alternative to other restorative techniques, offering several advantages. The present paper reports a case in which the treatment of a cervical crown fracture was accomplished by reattaching the tooth fragment with a flowable resin composite. Orthodontic root extrusion was performed with a modified Hawley appliance prior to fragment reattachment. The clinical and radiographic results after 2.5 years were successful.

Treatment of crown fractures with pulp exposure

Thirty permanent incisors with vital pulps and complicated crown fractures were treated by a partial pulpotomy (Cvek technique). This consisted of amputation of 1 to 2 mm of the exposed pulp, placement of calcium hydroxide powder, and a temporary restoration. Clinical and radiographic assessment of the hard tissue barrier was done after 3 months and again after 1 to 8 years. The treatment was successful in all incisors. No differences were found in stage of root development, size of exposure, and length of time exposed. In conclusion, the partial pulpotomy technique is a successful and permanent treatment for crown fractures with pulp exposure regardless of the size of exposure, the maturity of the root, or the interval between accident and dental treatment.