Trauma of maxillary incisors is frequent and dental practitioners have to be competent in managing the consequences. Complicated crown root fractures of anterior teeth can have profound aesthetic and psychological implications on patients. In younger patients, if extractions are considered, it can lead to complex prosthodontic challenges in the future. Ideally, an attempt should be made in restoring the traumatized teeth, so an effective aesthetic and functional result can be reached. This case report highlights the treatment of complicated crown root fractures on maxillary incisors using endodontics and fragment re-attachment of the fractured crowns. Twelve-month follow-up of the treatment demonstrated aesthetic and functional success and delayed the need for prosthetic replacement.
CPD/Clinical Relevance: This paper describes traumatic injuries of teeth and how management via fragment re-attachment of the fractured crowns has led to delay of definitive prosthetic treatment.
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Dental injuries are typically classified as displacements, fractures or combinations of the two.1,2 A crown-root fracture is defined by the fracture crossing enamel, dentine and cementum into the periodontal ligament.3 A complex injury will have pulpal involvement. These injuries are often associated with maxillary incisors4 and in patients before the age of 19.5
Once the fractured portion has been removed, an assessment must be made of the restorability of the tooth. Key considerations include the nature of the fracture, whether it is simple or complex. Further, the depth of the fracture must be assessed. In particular, if marginal isolation is possible without creating periodontal complications and the availability of remaining tooth structure to support restoration.
Where fractures are complex one must also assess the ability for optimal isolation with a rubber dam for possible endodontic treatment and, ultimately, the long-term restoration of the tooth.6 If a tooth is not restorable this can have profound implications for the patient. Never is this more important than in the growing patient for whom tooth loss may result in prosthodontic challenges in the future. As such, if a tooth is unrestorable, is it wise to leave the root in situ? If there is any possibility of restoration it should be considered, even if this is considered a provisional phase until adulthood, when more predictable solutions may be sought.
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