• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.45 no.5
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• pp.254-259
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• 2019

Objectives: Crown-root fracture and cervical caries in maxillary premolars constitute a challenge in cases of subgingival placement of restoration margins. Surgical extrusion has been practiced successfully in permanent anterior teeth. The aim of the present retrospective study was to assess the clinical outcome of surgical extrusion after orthodontic extrusion in maxillary premolars. Materials and Methods: Twenty-one single, tapered root maxillary premolars with subgingival crown-root fracture or caries were included. Presurgical orthodontic extrusion was performed on all teeth to prevent root resorption. Extent of extrusion and rotation was determined based on crown/root ratio. The postoperative splinting period was 7 to 14 days. Clinical and radiographic examination was performed at an interval of 1, 2, and 3 months. Results: After the mean follow-up of $41.9{\pm}15.2months$, failure was observed as increased mobility in 3 of 21 cases. No significant difference was observed in the outcome of surgical extrusion based on tooth type, age, sex, $180^{\circ}$ rotation, or time for extraction. Furthermore, marginal bone loss was not observed. Conclusion: Surgical extrusion of maxillary premolars can be a possible therapeutic option in cases of subgingival crown-root fracture.

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

• The Journal of Korean Academy of Prosthodontics
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• v.50 no.3
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• pp.204-209
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• 2012

Surgical extrusion, immediate extrusion following tooth luxation, is a method to preserve one's natural tooth and achieve esthetic restoration without additional periodontal surgery when subgingival dental caries or crown fracture occurs. A 16-year-old male was referred to the clinic from the department of operative dentistry for the esthetic restoration of maxillary left lateral incisor. Due to the crown to root fracture, the tooth was endodontically treated with a buccal crown length of 4 mm. When the palatal flap was elevated, the mesiopalatal cervical fracture area was situated 3-4 mm subgingivally. Crown lengthening was achieved through surgical extrusion. After 3 months of clinical observation and provisional restoration, the maxillary left central incisor was restored with all ceramic crown and obtained a satisfactory clinical result.

• Journal of the korean academy of Pediatric Dentistry
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• v.28 no.4
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• pp.575-582
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• 2001

There have been many treatment methods for traumatic subgingival crown fracture and intrusion without spontaneous eruption. The orthodontic forced eruption generally results in favorable clinical findings than crown lengthening with osteotomy and intentional replantation. In first two cases with subgingival crown fracture due to trauma, authors applied orthodontic forced eruption with axed appliance after root canal therapy and then restored them with composite resin. In another case with traumatic intrusive luxation, we observed spontaneous eruption of the corresponding tooth for about 6 months and then returning it to normal position by forced eruption with removable appliance, but root canal filling was conducted after apexification due to devitalization during forced eruption, and so clinically favorable results were obtained.

• The Journal of the Korean dental association
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• v.57 no.11
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• pp.679-688
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• 2019

A 8-year-old patient presented with a crown-root fracture of the maxillary right central incisor with an oblique subgingival fracture line. A multidisciplinary treatment approach including endodontic treatment, surgical extraction and intraalveolar repositioning was used to gain sufficient crown length of the fractured maxillary incisor. The coronally repositioned maxillary right central incisor was stabilized by a resin wire splint. Apexification using MTA was performed. Resin core and direct resin restoration(Cl IV) on fractured teeth was built up. Clinical and radiographic follow-up of the maxillary right central incisor after 36 months showed no signs of root resorption or pathology and acceptable aesthetics and functions were maintained. Surgical extrusion can be considered as a good treatment modality for young patients.

• Restorative Dentistry and Endodontics
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• v.35 no.5
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• pp.395-400
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• 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 Dental Rehabilitation and Applied Science
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• v.24 no.3
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• pp.243-251
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• 2008

A subgingival crown-root fracture presents a restorative problem to the clinician because restoration is complicated by the need to maintain the sound tooth structures. Forced eruption offers a method of treatment of teeth fractured close to the alveolar crest. Extrusion of such teeth allows elevating the fracture line above the epitherial attachment and so the proper finishing margins can be prepared. The purpose of this case is to report successful tooth restoration using forced eruption in case of crown-root fractures.

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

• Restorative Dentistry and Endodontics
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• v.33 no.1
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• pp.39-44
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• 2008

The treatment of esthetic areas with single-tooth implants represents a new challenge for the clinician. In 1993, a modification of the forced eruption technique, called "orthodontic extrusive remodelling," was proposed as a way to augment both soft- and hard-tissue profiles at potential implant sites. This case report describes augmentation of the coronal soft and hard tissues around a fractured maxillary lateral incisor associated with alveolar bone loss, which was achieved by forced orthodontic extrusion before implant placement. Through these procedures we could reconstruct esthetics and function in a hopeless tooth diagnosed with subgingival root fracture by trauma.

• Journal of Periodontal and Implant Science
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• v.38 no.3
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• pp.551-556
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• 2008

Purpose: Cemental tear is an uncommon form of root fracture that can lead to rapid localized attachment loss. When it is exposed in the periodontal pocket, it should be removed to prevent accumulation of dental plaque and calculus. Material and Methods: 2 patients were diagnosed as a cemental tear and they were treated with conventional flap operation and subgingival curettage. Additional treatments such as bone graft or guided tissue regeneration were not performed. Result: Symptoms subsided after the treatment. Periodontal pocket has been reduced but no gain of clinical attachment was observed. Remnant of cemental fragment remained after curettage. However, periodontal pocket was stably maintained and there was no recurrence. Conclusion: Periodontal attachment loss associated with cemental tear can be successfully treated with conventional periodontal surgical and nonsurgical procedures.