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Trauma with an accompanying fracture to the anterior teeth gives an agonizing experience for a young individual due to the physical disfigurement and the psychological impact that is imposed on them. This paper reports a case of complicated crown-root fracture in a young child that was treated by extra-oral fragment reattachment followed by the intentional reimplantation. The tooth was endodontically-treated followed by the placement of fiber-reinforced composite post. The fragments were reattached extra orally following an atraumatic extraction. The tooth was then reimplanted back into the socket followed by splinting. Clinical results were successful after 2 years. This case report demonstrates the importance of modifying a treatment protocol to maintain esthetics up to the completion of the developmental period.

The need to rehabilitate severely compromised teeth is frequent in daily clinical practice. Tooth extraction and replacement with dental implant represents a common treatment choice. However, the survival rate for implants is inferior to teeth, even if severely damaged but properly treated. In order to reestablish a physiological supracrestal tissue attachment of damaged teeth and to arrange an efficient ferrule effect, three options can be considered: crown lengthening, orthodontic extrusion and surgical extrusion. Crown lengthening is considered an invasive technique that causes the removal of part of the bony support, while both orthodontic and surgical extrusion can avoid this inconvenience and can be used successfully in the treatment of severely damaged teeth. The aim of the present narrative review is to compare advantages, disadvantages, time of therapy required, contraindications and complications of both techniques.

(1) Background: To assess orthodontic forced eruption (OFE) as a pre-restorative procedure for non-restorable permanent teeth with subgingival dental hard tissue defects after dental trauma. (2) Methods: A systematic electronic search of three databases, namely, MEDLINE, Cochrane Library, and EMBASE, revealed a total of 2757 eligible publications. Randomized controlled clinical trials (RCT), retro- and prospective clinical studies, or case series (with a minimum of three patients) were reviewed. (3) Results: Thirteen full-text papers were included: one RCT, one prospective clinical trial, two retrospective cohort studies, and nine case series. Within case series, statistical significance between age and cause of fracture (p < 0.03) was determined. The mean extrusion rate of OFE was 1.5 mm a week within a four to six weeks treatment period followed by retention. Three OFE protocols for maxillary single teeth are available: 1. OFE without migration of gingiva and alveolar bone, 2. OFE with gingival migration and slight alveolar bone migration, and 3. OFE with migration of both gingiva and alveolar bone. (4) Conclusions: The current state of the evidence suggests that OFE is a feasible pre-treatment option for non-restorable permanent teeth. OFE can promote the migration of tooth surrounding hard and soft tissues in the esthetic zone. Root resorption does not seem to be a relevant side effect of OFE.

An oblique crown-root fracture was detected incidentally in the cervical middle third of the mesial root of a non-endodontically treated second lower right molar. Because the tooth was asymptomatic, the pulp responded positively to testing and no periapical pathosis was detected, an endodontic treatment was not indicated. Considering the unusual condition of tooth 47, substantial efforts were made to save tooth 46, which had been extensively destroyed by caries. A control cone beam computed tomography (CBCT) acquired 12 months after completion of the endodontic treatment of tooth 46 revealed almost complete resolution of the periapical pathosis in the first right molar, no changes in the fracture line and no periradicular radiolucency in the second right molar. The loss of this tooth could have resulted in postextraction atrophy of the alveolar bone and loss of support for the fractured root of the adjacent tooth.

Background Complicated crown-root fractures are a type of tooth fracture that involves the enamel, dentin, and cementum and accompanied by pulp exposure. The treatment of a complicated crown-root fracture is always challenging due to the difficulties in achieving a hermetic seal and a stable restoration with a fracture level close to the crestale bone level. This study aimed to evaluate and compare the efficacy of single-visit and multi-visit approaches for fragment reattachment in complicated crown-root fractures of anterior teeth. Methods Two cohort consist of 10 adolescent patients in each group at both genders, who suffered from permanent anterior tooth complicated crown-root fracture were included. Fragment reattachment with root canal treatment was performed with either single or multiple-visit approach. Single visit fragment attachement combined with root cannel therapy was conducted in single-visit approach group immediately after injury. Fragment attachment, root cananel therapy and post resoration were performed during three times ‘ clinical visit in multi-visit approach group. Results All the patients in both groups achieved satisfactory aesthetic results one year after fragment reattachment. Patients who underwent a multi-visit approach had a significantly shorter operative duration, less intra-operative pain and fatigue, slightly better periodontal health at an early stage, and a decreased incidence of temporomandibular joint disorders compared to those who underwent a single-visit approach. However, multiple visits approach may increase the risk of fragment detachment postoperatively. Conclusion Fragment reattachment a reliable but temporary technique for adolescent patients who have suffered from complicated crown-root fractures. Multi-visit approach showed similar effecacy to single-visit approach but with slightly less complications. The choose of these two merhos should depend on the specific patient situation and patient compliance. Trial registration This prospective cohort study was retrospectively registered in Chinese Clinical Trial Registry (ChiCTR2300076811) on 19/10/2023.

Crown‐root fragment reattachment is an efficient method for restoring fractured teeth but is prone to failure due to complications such as microleakage or improper alignment, particularly when moisture control is compromised. In this case, the maxillary left central incisor that had sustained a complicated crown‐root fracture was successfully reattached through a meticulously planned adhesive protocol. Specifically, precise visual reattachment on a small periodontal flap using the Super‐Bond adhesive system in a controlled moisture led to favorable long‐term results. The 55‐month follow‐up shows that conservative reattachment can restore function and appearance and preserve periodontal health.

Traumatic dental injuries (TDI) are frequent among individuals of all ages, with a prevalence ranging from 12–22%, with crown and crown–root fractures being the most common. Fragment reattachment using light-cured nanocomposites is the recommended method for the management of these fractures. Though there are several clinical studies that have assessed the efficacy of such materials, an in-silico characterization of the effects of traumatic forces on the re-attached fragments has never been performed. Hence, this study aimed to evaluate the efficacy of various adhesive materials in crown and crown–root reattachments through computational modelling. A full-scale permanent maxillary anterior tooth model was developed by segmenting 3D scanned cone beam computed tomography (CBCT) images of the pulp, root, and enamel precisely. The full-scale 3D tooth model was then subjected to a novel numerical cutting operation to describe the crown and crown–root fractures. The fractured tooth models were then filled computationally with three commonly used filler (or adhesive) materials, namely flowable composite, resin cement, and resin adhesive, and subjected to masticatory and traumatic loading conditions. The flowable composite demonstrated a statistically significant difference and the lowest produced stresses when subjected to masticatory loading. Resin cement demonstrated reduced stress values for crown–root fractures that were masticatory loaded after being reattached using adhesive materials. During traumatic loading, resin cement demonstrated lower displacements and stress values across both fractures. The novel findings reported in this study are anticipated to assist dentists in selecting the most appropriate adhesive materials that induce the least stress on the reattached tooth when subjected to second trauma, for both crown and crown–root fractures.

Background Preservation of a healthy periodontium is critical for the long-term success of restored teeth. In cases of extensive caries, tooth fracture, inadequate crown length, and increased esthetic demands, the restorative margins need to be placed apical to the gingival margin. Violation of the biological width due to dental trauma frequently appears in clinical practice. There are three treatment options for preserving biological width and the ferrule effect: crown lengthening, orthodontic extrusion, and surgical extrusion. This case report describes the surgical intervention and fixed prostheses for crown-root fractured maxillary incisors in a growing patient. Case presentation A fourteen-year-old boy was referred from Department of Oral and Maxillofacial Surgery and visited the Department of Pediatric Dentistry after emergency dental treatment. He got hit with a baseball bat and his upper right central and lateral incisors were fractured with pulp exposure. A vertical fracture line extended 2 mm below gingival margin was observed. Surgical extrusion and conventional root canal treatments were performed on both fractured teeth. Surgical crown lengthening was additionally done to preserve the biological width and to make sure of the ferrule effect. Then, these teeth were finally restored with porcelain fused metal crowns. Conclusions Surgical extrusion and crown lengthening may be considered the most effective treatments to save the teeth instead of coronectomy or extraction for severely fractured teeth. The case described here showed satisfactory esthetic and periodontal outcomes during two years of follow-up, and the patient was satisfied that he could retain his natural teeth.

Background Pediatric anterior teeth complex crown-root fractures has high incidence and pose greater treatment challenges. Dynamic tooth development increases risks for orthodontic, periodontal, and restorative treatments. Case description The authors present a case of a 12-year-old boy with a complex crown-root fracture in the right maxillary central incisor. Initial treatment involved following IADT guidelines and extracting the fractured crown for orthodontic and restorative care. Collaboration among periodontists, orthodontists, and restorative dentists facilitated orthodontic traction and resin restoration, along with subgingival restoration surface treatment, improving periodontal health. Over 8 years, stable tooth and periodontal health with satisfactory aesthetics were observed, without inflammation or pain. Conclusion Follow-up of 8 years showed favorable prognosis for the affected tooth, highlighting the essential role of periodontists and consideration of periodontal health in managing complex crown-root fractures in children.

Objective: To explore the influence of combined endodontic-orthodontic treatment on the recovery of masticatory function in patients with crown-root fractures of permanent maxillary anterior teeth. Methodology: This retrospective analysis included clinical data of 118 patients with crown-root fractures of permanent maxillary anterior teeth admitted to Yulin First hospital from March 2020 to March 2024. Among them, 56 patients who received conventional restoration treatment were set as the control group, and 62 patients who received combined endodontic-orthodontic treatment were set as the study group. The treatment effects, oral-related indicators before and after treatment [gingival index (GI), periodontal probing depth (PPD), tooth mobility (TM)], bite force, masticatory efficiency, and subjective satisfaction were analyzed. Results: The total efficacy of the study group (95.16%) was higher than that of the control group (83.93%) (P < 0.05). After treatment, the levels of GI, PPD, and TM in both groups decreased compared to pre-treatment, and were considerably lower in the study group (P < 0.05). The excellent-good rate of bite force in the study group (93.55%) was higher than that in the control group (80.36%) (P < 0.05). Similarly, combined endodontic-orthodontic treatment was associated with a higher excellent-good rate of masticatory efficiency (93.55%) than that of the conventional restoration (78.57%) (P < 0.05). The subjective satisfaction in the study group (95.16%) was higher than that in the control group (82.14%) (P < 0.05). Conclusion: The combined endodontic-orthodontic treatment for crown-root fractures of permanent maxillary anterior teeth can effectively improve the oral condition, enhance the bite force and masticatory efficiency, with higher treatment effects and subjective satisfaction. This approach may represent a promising treatment option for patients with crown-root fractures of permanent maxillary anterior teeth, pending further validation through prospective and multicenter studies.