Treatment of crown-root fracture with a modified crown fragment reattachment technique

Article information

Restor Dent Endod. 2010;35(5):395-401

Publication date (electronic) : 2010 September 30

doi : https://doi.org/10.5395/JKACD.2010.35.5.395

Chang-Won Song, DDS , Min-Ju Song, DDS, MS , Su-Jung Shin, DDS, MS , Jeong-Won Park, DDS, PhD

Department of Conservative Dentistry, Gangnam Severance Hospital, Yonsei University College of Dentistry, Seoul, Korea.

Correspondence to Jeong-Won Park, DDS, MSD, PhD. Associate Professor, Department of Conservative Dentistry, Gangnam Severance Hospital, Yonsei University College of Dentistry, 712 Unjuro Dogokdong Gangnam-gu, Seoul, Korea 135-720. Tel, +82-2-2019-1350; Fax, +82-2-3463-4052; pjw@yuhs.ac

Received 2010 July 15; Revised 2010 July 29; Accepted 2010 August 05.

Abstract

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.

Keywords: Biologic width; Crown fragment reattachment; Crown root fracture; Periodontal attachment; Subgingival fracture

Notes

This case report was awarded in the 133rd spring scientific meeting of KACD in 2010 and supported for the publication by KACD.

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Figure 1

Preoperative photo and radiograph when patient came to the clinic.

Figure 2

Removed fragment of the fractured tooth. Fracture line was located 3 mm under CEJ. CEJ, cementoenamel junction.

Figure 3

Papilla preservation flap was reflected for crown reattachment procedure. Fracture line was extended to the equigingival area.

Figure 4

Adaptation of the modified fragment using premade putty index. Margin of the coronal fragment was trimmed off and it is short from the bone margin.

Figure 5

Rubber dam was placed with #211 clamp and fiber post was inserted (a). Coronal fragment was cemented with Duolink (b).

Figure 6

Fracture line was covered by composite resin with external chamfer preparation due to strengthening the cemented fragment.

Figure 7

6 month later, patient came back due to accidental fracture during mastication.

Figure 8

Coronal fragment was re-cemented without flap reflection.

Figure 9

2-year follow up photo. Slight discoloration and marginal gingivitis was found, but probing depth is normal.

Figure 10

2-year follow up radiograph.

Figure 11

Fracture pattern (From Dean, Avery and Swartz, Pediatric Dentistry 1986).