Survival of a hopeless tooth: A case report with 7 years of follow-up

Abstract

Traumatic dental injuries are common problems for both children and adults, with maxillary central incisors being affected most often. Anterior tooth injuries are challenging because they may require emergency care, and these patients are apprehensive due to the impaired function, aesthetics and phonetics. While crown fractures occur at the highest percentage of all traumatic injuries to the permanent dentition, crown-root fractures represent only 5%.[1,2] A crown-root fracture usually results in the loss of the tooth crown below the gingival margin, which can cause many problems with regard to endodontic isolation, periodontal maintenance and restoration. When the fracture line extends below the marginal bone level, several treatment options are available, including a mucogingival flap and reattachment of the original fragment,[3] surgical extrusion,[4] orthodontic extrusion[5] and intentional replantation.[6] The treatment approach depends primarily A crown-root fracture usually results in the loss of the tooth crown below the gingival margin, and this can create many problems during treatment. This case report presents the management of a complicated crown-root fracture using a multidisciplinary approach including surgical extrusion for crown lengthening, endodontic treatment and a composite restoration. A 23-year-old male patient presented to the Clinic of Endodontics with a complicated crown-root fracture of right maxillary lateral incisor. The intraoral periapical radiographic examination showed coronal tooth loss, the presence of three oblique crown-root fractures and a periapical lesion. Initially, the root canal was prepared, cleaned and temporarily filled with calcium hydroxide; then, the fractures were fixed using composite resin. At the next appointment, a surgical extrusion was performed, and the teeth were splinted with Ribbond bondable reinforcement ribbon. The splint was removed after 8 weeks, and the root canal was obturated. Finally, the tooth was restored using a fibre post-core system and composite resin. After 7 years of follow-up examinations, there were no radiographic or clinical signs of ankylosis, marginal bone loss or periapical disease. Moreover, satisfactory functional and aesthetic outcomes were observed.