Journal Article

Combined treatment of surgical extrusion and crown lengthening procedure for severe crown-root fracture of a growing patient: a case report

Lee, Bumjoon, Shin, Jonghyun, Lee, Eungyung, Park, Soyoung, Jeong, Taesung

2024

Overview

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.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Adolescent / Biologic width / Case Report / Case reports / Comparative analysis / Composite materials / Connective tissue / Crown Lengthening - methods / Crown lengthening procedure / Crown-root fracture / Crowns / Dental caries / Dental pulp / Dental restorative materials / Dentistry / Endodontics / Ferrule effect / Fractures / Humans / Incisor - injuries / Incisor - surgery / Incisors / Male / Maxilla - surgery / Maxillofacial / Medicine / Methods / Oral and Maxillofacial Surgery / Oral surgery / Orthodontic Extrusion - methods / Orthodontics / Patient outcomes / Patients / Pediatrics / Pedodontics / Periodontium / Prostheses / Prosthetics / Root canal therapy / Root Canal Therapy - methods / Root canals / Skin & tissue grafts / Surgery / Sutures / Teeth / Tooth Crown - injuries / Tooth Crown - surgery / Tooth extractions / Tooth Fractures - surgery / Tooth Root - injuries / Tooth Root - surgery