Intentional Replantation with 180° Rotation of a Crown-Root Fracture as a Last Expedient: A Case Report

The treatment of complicated crown-root fractures of tooth is often compromised by a fracture apical to the gingival margin and/or bone. This makes isolation difficult and compromises the adhesive union which is critical for a successful treatment. In the present case, the fracture line extended from cervical third of labial surface to cervical third of palatal surface sub gingivally which made the case a complicated crown root fracture. The reattachment of fragments would bring the vulnerable joint in the primary stress bearing area and in the subgingival region. Hence the tooth was removed traumatically with the help of periotome and intentional replantation was done which facilitated the attachment of fragments extra orally. Fragments reattachment was reinforced with the intraradicular fiber post and glass ionomer cement. Then the tooth was rotated 1800 to bring the subgingival fracture line to the labial surface where the occlusal load is less. As the amount of extra oral time is a critical factor in the success of reimplantation, the procedure was completed in 20 minutes. The teeth were stabilized with semi rigid splint for 6 weeks. Later full veneer crown was cemented on the tooth. The patient was followed up with clinical examination for mobility test, gingival sulcus depth and radiographic analysis to analyze the integrity of root, the alveolar cortex and the periodontal space for 12 months. The treatment is successful so far and has rendered satisfaction to both the clinician and patient.