J Dent Rehabil Appl Sci.  2020 Dec;36(4):262-271. 10.14368/jdras.2020.36.4.262.

A multidisciplinary approach to restore crown-root fractured maxillary central incisors: orthodontic extrusion and surgical extrusion

• Kwon EY
• Kim SY
• Jung KH
• Choi YK
• Kim HJ
• Joo JY

• KMID: 2512121
• DOI: http://doi.org/10.14368/jdras.2020.36.4.262

Abstract

To restore a tooth with a fracture line extending below the marginal bone level, a surgical crown lengthening procedure accompanied by ostectomy could be considered to expose the fracture line and reestablish the biologic width. However, this procedure could lead to esthetic failure, especially in the anterior teeth. Therefore, orthodontic extrusion, which elevates the fracture line from within the alveolar socket without sacrificing the supporting bone and gingiva, is recommended. This technique allows for the proper placement of the crown on a sound tooth structure, with the reestablishment of the biologic width. Alternatively, surgical extrusion is an one-step procedure that is simpler and less time-consuming than orthodontic extrusion; placing and adjusting the orthodontic appliance does not require multiple visits. This study presents successful restoration in 2 cases with a crown-tooth root fracture of the maxillary central incisor treated using a multidisciplinary approach through orthodontic extrusion or surgical extrusion followed by successful restoration.

Keyword

crown lengthening; orthodontic extrusion; surgical extrusion; tooth fractures

Figure

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  Fig. 1 Pretreatment clinical view and radiograph of case 1. Note fracture line of maxillary left central incisor extended below the buccal gingival after removal of fractured buccal crown fragment (A). Figure (B) represents the initial state which was not removed fractured buccal crown fragment.

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  Fig. 2 After a 10-week orthodontic extrusion and followed by a 6-week retention phase. Note the coronal migration of the gingiva in the buccal aspect of extruded tooth.

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  Fig. 3 During surgical clinical crown lengthening, the flap was reflected and osseous resection was performed to achieve adequate distance for biological width with exposure of fracture margin (A). The flap was sutured back to the position (B). Temporary crown was adjusted for marginal gingival adaptation (C). After final prosthetic crown placement (D).

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  Fig. 4 Pretreatment clinical view and radiograph of case 2. Note fracture lines of maxillary right and left central incisor. Right central incisor was fractured above the gingival line but left central incisor showed the biologic width violation by subgingival crown fracture with complete loss of the crown.

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  Fig. 5 Buccal view of coronally positioned root splinted with composite resin to maintain tooth stability and sutured (A). One-week after surgical extrusion. Wound healing was uneventful and suture was removed (B). After complement of endodontic treatment and gingivectomy, reconstruction of crown with core and post was done (C). Temporary crown was adjusted for marginal gingival adaptation (D).

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  Fig. 6 Clinical view after final prosthetic crown placement (A). Two-year follow-up clinical view showed harmonious soft tissue contour (B).

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  Fig. 7 Radiograph taken right after surgical extrusion (A), at crown delivery (B), at 1-year follow-up (C) and at 2-year follow-up (D). Note the resolution of periapical radiolucency and there was no signs of root resorption or ankylosis.

Reference

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