The management of traumatic dental injuries as well as crown-root Fractures is always challenging in everyday general dental practice. A number of treatment modalities are available for crown-root Fractures, depending on the position, extent and severity of the fracture. The aim of this case report was to describe a clinical case of rehabilitation of a complicated crown-root fracture of the maxillary left central incisor, successfully treated by a multidisciplinary approach including orthodontic extrusion. The final result was esthetically pleasant and periodontally sound in the follow ups.

Acute traumatic injuries to the maxillary incisors may lead to a crown-root fracture. If the fracture is left untreated, the fracture line will propagate and extend apically, resulting in microbial contamination of the attachment apparatus and subsequent bone loss. In cases with extensive periodontal involvement, extraction has been suggested. However, bonding and sealing the fracture line with a biocompatible material seems to be an effective alternative treatment option. In this case report, management of a central incisor with an incomplete crown-root fracture that showed signs and symptoms of vertical root fracture is discussed. As the extension of the fracture line was not clear, intentional replantation and sealing the fracture line with a glass ionomer was performed. The Tooth showed no signs and symptoms at sixmonth follow up, and the radiographic examination exhibited substantial bone repair.

Teeth with root fracture may need orthodontic treatment. This case report presents the management of unerupted canines in a patient with previously-healed/untreated horizontal root fracture in the maxillary left central incisor. The malocclusion was treated maintaining pulp vitality considering the principles to improve the eruption path of maxillary canines and move short-rooted teeth. The root-fractured Tooth remained symptomless after orthodontic treatment without significant adverse effects, and stayed stable following 2-year follow-up.

Background and Aim: This study compared the fracture resistance and esthetic appearance of reattached incisor Tooth fragments with different preparation techniques in simulated crown Fractures (CFs). Materials and Methods: In this in vitro study, 50 permanent maxillary incisors were randomly divided into five groups (n=10). After induction of uncomplicated CFs, the fractured teeth were restored using five methods: (I) simple reattachment (SR), (II) circumferential chamfer (CC), (III) buccal scalloped bevel and lingual bevel (BSB&LB), (IV) buccal and lingual overcontour (BO&LO), and (V) buccal scalloped bevel and lingual overcontour (BSB&LO). After thermocycling, the fracture resistance of the teeth was measured, and their esthetic appearance was assessed using Easyshade spectrophotometer and the United States Public Health Service (USPHS) visual scale. One-way ANOVA, Tukey’s post-hoc test, and paired t-test were used to analyze the data (alpha=0.05).  Results: The secondary fracture resistance was significantly lower than the primary fracture resistance in the control (P=0.000), CC (P=0.01), BSB&LB (P=0.004), BO&LO (P<0.001), and BSB&LO (P<0.001) groups. The CC group showed a significantly higher secondary fracture resistance than the BO&LO group (P=0.02). Although a more favorable esthetic appearance was observed in the BSB&LB group, no significant difference was found in color difference (∆E) among the groups. Moreover, no statistically significant difference was detected among the study groups regarding the USPHS scale (P>0.05). Conclusion: Restoration with the CC method may improve the fracture resistance of reattached fragments in simulated CFs in maxillary incisors. However, no considerable difference was found regarding the esthetic appearance among the tested techniques.

One of the most challenging issues in the field of dentistry is to decide whether to preserve or extract a compromised Tooth with subgingival caries/crown Fractures. Several patient-related factors (i.e. biological, behavioral, or financial factors), Tooth-related factors (i.e. periodontal, endodontic, or restorative factors), and the role of the Tooth in the overall treatment plan should be considered to make the most accurate decision. This article has focused on the decision-making process related to the management of compromised teeth with subgingival caries/crown Fractures. Based on the current scientific evidence and clinical experience of the authors, an algorithm has been suggested to simplify this process of decision. In the first step, compromised teeth were classified as single-root or multi-root groups. “Crown-to-root ratio” (C/R ratio), and “apical extension of caries to the crestal bone” were considered the main clinical parameters in the decision-making process for single-root and multi-root teeth, respectively. We do not recommend restoring the compromised teeth if the C/R ratio is more than 1 (for single-root teeth) or if the extension of caries has reached the alveolar bone crest (for multi-root teeth). For maintainable single-root teeth, there are three treatment options to provide space for the re-establishment of supracrestal soft tissue attachment (previously named as biologic width) between the future restorative margin and underlying crestal bone. These approaches include: surgical crown lengthening (SCL), orthodontic forced eruption (OFE), and deep marginal elevation (DME). For multi-root teeth, SCL and DME are usually the procedures of choice. Multi-root teeth are not amenable to OFE due to the heavy orthodontic forces needed for extrusion. We also discussed the indications and limitations related to each treatment option. Further studies should be conducted to evaluate the external validity of this decision tree.

This case report documents the clinical approach adopted for two maxillary incisors with intrusion and horizontal root fracture in the middle third after trauma. The proposed procedures involved maintaining pulp vitality and periodontal stability of the fractured teeth with 8 years of follow-up.

The crown-root fracture is a common Tooth injury which compromises the biological width and need proper endodontic and prosthodontic treatment to achieve acceptable clinical outcome. This case report describes clinical management of crown-root fracture in maxillary central incisors which was successfully treated by forceps eruption with 180˚ rotation to restore the biological width. The patient was followed-up for 18 months. Clinical and radiographic evaluation showed acceptable results, the replanted teeth have normal function and no obvious inflammatory root resorption was seen on radiographic examination.