S.R. Fidel et al.
Clinical Management of a Complicated Crown-Root Fracture: A Case Report
Sandra Rivera FIDEL1 Rivail Antonio Sergio FIDEL-JUNIOR2 Luciana Moura SASSONE1 Cristiana Francescutti MURAD1 Rivail Antonio Sergio FIDEL1
- Rio de Janeiro State University, Rio de Janeiro, RJ, Brazil de Almeida University,Rio de Janeiro, RJ, Brazil
This report describes the clinical procedures involved in the treatment of a complicated crown-root fracture in the maxillary left central incisor with a wide open apex of a 10-year-old male patient, due to fall from his own height. Post-trauma treatment comprised cervical pulpotomy and adhesive tooth fragment reattachment. After 1 year, clinical and radiographexaminations showed pulp necrosis and an associated periapical lesion. Endodontic therapy with calcium hydroxide-base intracanal dressing, root canal filling and orthodontic extrusion were performed. Extrusion was completed within approximately 16 weeks and the tooth was restored with a post-core system and a prosthetic crown. After a 3 years of follow-up, there was no evidence of apical periodontitisand the tooth was satisfactory both esthetically and functionally. Key Words: crown-root fracture, traumatic dental injuries, permanent tooth, orthodontic extrusion.
Traumatic injuries to teeth and their supporting tissues usually occur in young people and damage may vary from enamel fracture to avulsion, with or without pulpal involvement or bone fracture. A crown-root fractureis a type of dental trauma, usually resulting from horizontal impact, which involves enamel, dentin and cementum, occurs below the gingival margin and may be classified as complicated or uncomplicated, depending on whether pulp involvement is present or absent (1,2). Most of these injuries occur in permanent maxillary incisors before complete root formation and cause pulp inflammation or necrosis(1). Epidemiological statistics revealed that crown-root fractures represent 5% of dental injuries (1,3). Treatment of complicated crownroot fractures is often challenging due to difficulty in achieving isolation with a rubber dam for a dry operating field, which might comprised the hermetic seal (4). Dentoalveolar trauma during the maturation of permanent teeth may result in incomplete rootformation
and root resorption (5). The Hertwig’s epithelial root sheath may continue the process of root formation, even in the presence of pulp pathologies, if it remains intact (6,7). However, sheath destruction hinders the differentiation of odontoblast-like cells (6). Moreover, several techniques have been developed to induce hard tissue formation and apical closure. Among them, the use of acalcium hydroxide-based paste as an intracanal dressing has been reported to stimulate hard tissue formation and apexification after root canal therapy (6,8). Several therapeutic procedures can be indicated to treat teeth with complicated crown-root fracture, depending on fracture location (2,3,9). Treatment options of a subgingival or infraosseous fracture include orthodontic or surgicalextrusions, gingivectomy and osteotomy and intentional replantation. Orthodontic extrusion expose the fracture line by extruding the tooth with orthodontic forces, very similar to the movements involved in physiological root eruption. in spite of being a costly and time-consuming procedure, it is favorable to the preservation of pulp vitality and gingival health.
Correspondence: Profa. Dra. SandraRivera Fidel, Rua Dr Otávio Kelly 63/301, Tijuca, 20511-280 Rio de Janeiro, RJ, Brasil. Tel: +55-21-2587-6455. Fax: +55-21-2568-3056. e-mail: email@example.com Braz Dent J 22(3) 2011
Complicated crown-root fracture
In addition, orthodontic extrusion does not involve loss of alveolar bone or periodontal support and produces good aesthetic results (9-11). This report describes the...