• Journal of the korean academy of Pediatric Dentistry
• /
• v.35 no.2
• /
• pp.305-312
• /
• 2008

Crown-root fractures occur throughout both crown and root, and are defined as fractures involving enamel, dentin and cementum. The fractures may be grouped according to pulpal involvement into complicated and uncomplicated one. Crown-root fractures often occur on maxillary anterior teeth and comprise 5% of injuries affecting the permanent dentition and 2% in the primary dentition. To restore crown-root fractured tooth, biologic width must be maintained. For maintaining biologic width, such methods as gingivectomy following osteoplasty or orthodontic extrusion or surgical extrusion are available. Surgical extrusion is a method that extracts the tooth and replants the fractured tooth supragingivally. It is indicated when the length of the crown fragment is less than half the length of the clinical root. In these cases, root canal treatment and crown restoration using light-cured composite resin were performed after surgical extrusion. In following periodic examinations, favorable outcome was observed.

• Journal of the korean academy of Pediatric Dentistry
• /
• v.36 no.2
• /
• pp.288-292
• /
• 2009

A crown-root fracture is defined as a fracture involving enamel, dentin, and cementum. The fractures may be grouped according to pulpal involvement into uncomplicated and complicated. Generally a vertically crown-root fractured tooth must be extracted. However, it should be mentioned that the cases have been reported where bonding of the coronal fragment has led to consolidation of the intraalveolar part of the fracture. Definitive conservative therapy comprises one of four treatment alternatives; fragment removal only, fragment removal with gingivectomy, orthodontic extrusion of apical fragment, and surgical extrusion of apical fragment. The choice is primarily determined by the exact information on the site and the type of fracture, but the cost and the complexity of treatment can also be decisional factors. On the other hand, intentional replantation of the teeth with vertical root facture reconstructed with resin bonding has emerged as a new promising method in recent years. This case presents an intentional replantation of the crown-root fractured maxillary central incisor reconstructed with resin bonding. However, an obvious increase of radiolucency was observed after 4 months and the tooth was re-fractured after 16 months.

• Journal of the korean academy of Pediatric Dentistry
• /
• v.27 no.2
• /
• pp.256-261
• /
• 2000

Trauma to the tooth is the most common accidents in pediatric dentistry and tooth fracture occurs frequently. Fracture is classified into crown fracture, root fracture, and crown-root fracture which involves both. Also, it is classified into simple or complicated fracture depending on whether the pulp is exposed or not. When the fracture is extended down to the subgingival level following the long axis of the root, or when more than 1/3 of the root is involved, extraction is the primary treatment. But alternative treatment such as extruding the root fragment with orthodontic force and restoring it, or intentionally extracting the tooth and replanting it to a position which it can be restored. This is a case report on intentional replantation of a traumatized maxillary central incisor with crown-root fracture of a patient with mixed dentition. The teeth was extracted and immediate endodontic treatment, retrograde filling and resin restoration were carried out.

• Journal of the korean academy of Pediatric Dentistry
• /
• v.30 no.3
• /
• pp.465-470
• /
• 2003

Transverse and oblique crown-root fractures constitute a major therapeutic problem, particularly in young dentitions. Because crown-root fracture may involve enamel, dentin, pulp, and periodontal tissues, management of the injuries must be modified accordingly. When the fracture line was located under the alveolar crest. there are several methods for crown-root fractured teeth with pulp exposure, such as extruding the root fragment with orthodontic force and restoring it, or intentionally extracting the tooth and replanting it to a position which it can be restored. This case, the fractured tooth is intentionally extracted atraumatically, and replanted by rotating approximately 180 degree into the original socket and fixing with an orthodontic wire. At the 8-month recall examination, the root still showed normal mobility and there was not observed any inflammatory or replacement root resorption in the periapical radiograph.

• Journal of the korean academy of Pediatric Dentistry
• /
• v.37 no.3
• /
• pp.381-386
• /
• 2010

As the vertical fracture occurs at the various locations following the long axis of a root, treatment method of crown-root fractured anterior teeth is decided according to the depth. If the fracture line is close to the crown, gingivectomy, orthodontic - forced eruption or surgical extrusion of apical fragment could be done. If the line is over 1/3 length of the root, the prognosis is poor and extraction is usually undertaken. However, extraction of maxillary incisor at growing children causes many complications such as esthetic, phonetic problem and alveolar bone resorption. Therefore, preservation of tooth is the highest priority. Recently, intentional replantation with composite resin could be considered as alternative treatment of crown-root fractured anterior tooth. This report presents a patient in mixed dentition with deep vertical crown-root fracture of the maxillary permanent central incisors by trauma. Intentional replantation of the fractured teeth was performed using composite resin. After 2 years, specific clinical symptom has not been found and the patient was satisfied of esthetic result. This method suggests the new technique to preserve a tooth as an alternative to extraction, although it is technically sensitive and the reports of long-term prognosis is insufficient.

• Journal of the korean academy of Pediatric Dentistry
• /
• v.39 no.1
• /
• pp.58-65
• /
• 2012

The crown-root fracture is defined as a fracture of tooth that contains enamel, dentin and cementum with or without pulp exposure. Generally the fracture lines place obliquely from labial surface, between incisal edge of the crown and marginal gingiva, to palatal surface subgingivally. If the fracture line is located supragingivally, the removal of tooth fragment and supragingival restoration can be performed. In subgingival fracture line, the surgical exposure, orthodontic eruption or surgical eruption can be considered. If the fracture line is too deep to restorate, extraction or decoronation can be selected. In children and adolescents, the extraction should be the last option. Another option to select before extraction is the restoration using fiber-reinforced post and the reattachment of tooth fragment. The fiber-rainforced post enhances the retention and the durability of tooth fragment. The reattachment of crown fragment using resin adhesive system is considered minimal invasive treatment biologically. This case reports the treatment of crown-root fracture using the reattachment of crown fragment and the insertion of fiber-reinforced post.

• Journal of the korean academy of Pediatric Dentistry
• /
• v.31 no.2
• /
• pp.267-272
• /
• 2004

This case report describes an uncommon treatment method for crown-root fractured incisor with immature root. A 7-year-old girl was referred for treatment of crown-root fractured maxillary central incisor. The fracture line extended to 1/2 of the total tooth length with incomplete root formation. The prognosis of crown-root fracture is usually poor and extraction is usually undertaken. But, in the mixed dentition, extraction of maxillary permanent incisor results in many complications, such as resorption of alveolar bone, poor esthetics, pronunciation and mastication. Conservative therapy in the permanent dentition comprises of few treatment modalities; supragingival restoration, gingivectomy, orthodontic extraction of apical fragment, surgical extrusion of apical fragment with or without rotational replantation. However, in this case, these indications are not applicable, so intentional replantation with adhesive resin system is the treatment of choice. The tooth was followed-up for 12 months. Currently, there are no symptoms. Since this modality adopts the respective advantages of both intentional replantation and adhesive treatment, it might be the treatment of choice in cases of vertical crown-root fracture.

• Journal of the korean academy of Pediatric Dentistry
• /
• v.27 no.2
• /
• pp.344-350
• /
• 2000

Incidence of crown-root fracture due to traumatic injury, have been reported 3% in the permanent dentiton, 2% in the deciduous dentition. There are two treatment methods for crown-root fractured teeth with pulp exposure, when the fracture line was located under the alveolar crest. One way is the extrusion by orthodontic force the other way is intra-alveolar transplantation which occlusally repositioning of apical fragment in the alveolar socket. Since intra-alveolar transplantation has introduced in 1970s, it was practiced as alternative to orthodontic extrusion. As the result, this method may thoughted that had a good prognosis. As a result of trauma, completely crown-root fracture was occured in the maxillary right central incisor in this case. We couldn't reposition the deepest fracture line above the alveolar crest by the conventional surgical extrusion, because apical fragment was too short. Thus, after extraction of apical fragment, we repositioned it to the socket following demineralized freezed dried bone graft, which possible to support the apical fragment. At the 15-month recall examination, the root still showed normal mobility and there was not observed any in flammatory or replacement root resorption in the periapical radiograph.

• Restorative Dentistry and Endodontics
• /
• v.35 no.5
• /
• pp.395-400
• /
• 2010

The development of adhesive dentistry has allowed that the crown fragment reattachment can be another option in the treatment of crown fracture. However, additional crown lengthening procedure or extrusion of the tooth may be necessary in the treatment of crown root fracture because subgingival fracture line in close proximity to the alveolar bone leads to challenges for restorative procedure and the violation of the biologic width. This case report presents a modified crown fragment reattachment technique of crown root fracture with pulp exposure, which was done without additional crown lengthening procedures. After the endodontic treatment, the patient was treated using a post insertion and the fragment reattachment technique, which made it possible to preserve the space for the biologic width and maintain a dry surgical field for adequate adhesion through the modification of the fractured coronal fragment. Since a coronal fracture was occurred and reattached afterward, it was observed that the coronal fragment was well maintained without the additional loss of periodontal attachment through 2-year follow up.

• Journal of the korean academy of Pediatric Dentistry
• /
• v.30 no.3
• /
• pp.385-390
• /
• 2003

Traumatic injuries in the young permanent dentition are common, but root fractures, defined as fractures involving dentin, cementum and pulp, are relatively uncommon. Appropriate management of root fracture involves repositioning the coronal portion of the tooth fragment and firm immobilization with a splint for 2 to 3 month. Root canal treatment should not be initiated until the sign of necrosis or resorption are apparent because in most cases, the apical fragments maintain their vitality. The following case report describes a patient with root fractures injured three times over the period of 7 years. The results, clinically and radiographically, were acceptable, but long term periodic evaluation is required.