Aim: The aim of this article is to report a successful treatment of a complicated crown-root fracture.
Background: The management of complicated crown-root fracture in young patients is challenging as the fracture line is below the bone crest and the pulp is exposed. Treatment options include crown lengthening, orthodontic extrusion, and intentional replantation.
Case description: Here, a case of complicated crown-root fracture of tooth number 11 in a ten-year-old boy is presented. Intentional replantation with 180° rotation and slight extrusion and fixation was performed. In addition, root canal therapy was done and tooth was restored with a composite resin after four weeks. The patient was asymptomatic clinically and radiographically after three-year follow-up.
Conclusion: Intentional replantation with 180° rotation is a valuable treatment for crown root fractures.
Clinical significance: The management of complicated crown-root fracture using intentional replantation with 180° rotation can help to maintain natural dentition and interdental papilla.
Shulman JD, Peterson J. The association between incisor trauma and occlusal characteristics in individuals 8-50 years of age. Dent Traumatol 2004;20(2):67–74. DOI: 10.1111/j.1600-4469.2004.00234.x.
Andreasen JO, Andreasen FM. Crown-root fractures. In: Andreasen JO, Andrasen FM, Andersson L. ed. Textbook and Color Atlas of Traumatic Injuries to the Teeth, 4th ed. Oxford: Blackwell; 2007. pp. 314–366.
Bittencourt GS, Almeida F, et al. Intentional replantation with tooth rotation as indication for treatment of crown-root fractures. Braz J Dent Traumatol 2009;1(1):2–6.
Padbury Jr A, Eber R, et al. Interactions between the gingiva and the margin of restorations. J Clin Periodontol 2003;30(5):379–385. DOI: 10.1034/j.1600-051X.2003.01277.x.
Chung MP, Wang SS, et al. Management of crown-root fracture tooth by intra-alveolar transplantation with 180-degree rotation and suture fixation. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2010;109(2):e126–e130. DOI: 10.1016/j.tripleo.2009.09.014.
Hempton TJ, Dominici JT. Contemporary crown-lengthening therapy: a review. J Am Dent Assoc 2010;141(6):647–655. DOI: 10.14219/jada.archive.2010.0252.
Yuzugullu B, Polat O, et al. Multidisciplinary approach to traumatized teeth: a case report. Dent Traumatol 2008;24(5):e27–e30. DOI: 10.1111/j.1600-9657.2008.00603.x.
Tegsjo U, Valerius-Olsson H, et al. Intra-alveolar transplantation of teeth with cervical root fractures. Swed Dent J 1978;2(3):73–82.
Fariniuk LF, Ferreira EL, et al. Intentional replantation with 180 degrees rotation of a crown-root fracture: a case report. Dent Traumatol 2003;19(6):321–325. DOI: 10.1046/j.1600-9657.2003.00216.x.
Bindo TZ, de Morais EC, et al. Multidisciplinary approach of a crown-root fracture using intentional replantation: a case report. Pediatr Dent 2010;32(5):428–432.
Sahebi S, Dolatkhah V, et al. Management of a crown-root fracture in central incisors with 180 rotation: a case report. Iran Endod J 2011;6(4):183–187.
Kim DS, Shin DR, et al. Management of complicated crown-root fractures using intentional replantation: two case reports. Dent Traumatol 2013;29(4):334–337. DOI: 10.1111/j.1600-9657.2011.01075.x.
Shanmugam J, Mahendran K, et al. Management of complicated Crown root fractured teeth by intra alveolar transplantation with 180° rotation: case series. SRM J Res Dent Sci 2014;5(3):203. DOI: 10.4103/0976-433X.138763.
Sherman Jr P. Intentional replantation of teeth in dogs and monkeys. J Dent Res 1968;47(6):1066–1071. DOI: 10.1177/00220345680470061101.
Peer M. Intentional replantation - a ‘last resort’ treatment or a conventional treatment procedure? nine case reports. Dent Traumatol 2004;20(1):48–55. DOI: 10.1046/j.1600-4469.2003.00218.x.
Kahnberg KE. Intra-alveolar transplantation. I. A 10-year follow-up of a method for surgical extrusion of root fractured teeth. Swed Dent J 1996;20(5):165–172.
Wang Z, Heffernan M, et al. Management of a complicated crown-root fracture in a young permanent incisor using intentional replantation. Dent Traumatol 2008;24(1):100–103. DOI: 10.1111/j.1600-9657.2006.00487.x.
Asgary S, Alim Marvasti L, et al. Indications and case series of intentional replantation of teeth. Iran Endod J 2014;9(1):71–78.
Polimeni G, Xiropaidis AV, et al. Biology and principles of periodontal wound healing/regeneration. Periodontol 2006;41:30–47. DOI: 10.1111/j.1600-0757.2006.00157.x.
Pohl Y, Filippi A, et al. Results after replantation of avulsed permanent teeth. II. Periodontal healing and the role of physiologic storage and antiresorptive-regenerative therapy. Dent Traumatol 2005;21(2):93–101. DOI: 10.1111/j.1600-9657.2004.00298.x.
Andreasen JO. A time-related study of periodontal healing and root resorption activity after replantation of mature permanent incisors in monkeys. Swed Dent J 1980;4(3):101–110.
Pohl Y, Filippi A, et al. Results after replantation of avulsed permanent teeth. I. Endodontic considerations. Dent Traumatol 2005;21(2):80–92. DOI: 10.1111/j.1600-9657.2004.00297.x.
Caliskan MK, Turkun M, et al. Delayed replantation of avulsed mature teeth with calcium hydroxide treatment. J Endod 2000;26(8):472–476. DOI: 10.1097/00004770-200008000-00011.
Sathorn C, Parashos P, et al. Antibacterial efficacy of calcium hydroxide intracanal dressing: a systematic review and meta-analysis. Int Endod J 2007;40(1):2–10. DOI: 10.1111/j.1365-2591.2006.01197.x.
Mohammadi Z, Dummer PM. Properties and applications of calcium hydroxide in endodontics and dental traumatology. Int Endod J 2011;44(8):697–730. DOI: 10.1111/j.1365-2591.2011.01886.x.
Flores MT, Andersson L, et al. Guidelines for the management of traumatic dental injuries. II. Avulsion of permanent teeth. Dent Traumatol 2007;23(3):130–136. DOI: 10.1111/j.1600-9657.2007.00605.x.
Flores MT, Andersson L, et al. Guidelines for the management of traumatic dental injuries. I. Fractures and luxations of permanent teeth. Dent Traumatol 2007;23(2):66–71. DOI: 10.1111/j.1600-9657.2007.00592.x.
Berude JA, Hicks ML, et al. Resorption after physiological and rigid splinting of replanted permanent incisors in monkeys. J Endod 1988;14(12):592–600. DOI: 10.1016/S0099-2399(88)80056-6.
Andersson L, Andreasen JO, et al. International Association of Dental Traumatology guidelines for the management of traumatic dental injuries: 2. Avulsion of permanent teeth. Dent Traumatol 2012;28(2):88–96. DOI: 10.1111/j.1600-9657.2012.01125.x.
Iqbal MK, Kim S. A review of factors influencing treatment planning decisions of single-tooth implants vs preserving natural teeth with nonsurgical endodontic therapy. J Endod 2008;34(5):519–529. DOI: 10.1016/j.joen.2008.01.002.
Gotfredsen K, Carlsson GE, et al. Implants and/or teeth: consensus statements and recommendations. J Oral Rehabil 2008;35(Suppl 1):2–8. DOI: 10.1111/j.1365-2842.2007.01833.x.
Olsburgh S, Jacoby T, et al. Crown fractures in the permanent dentition: pulpal and restorative considerations. Dent Traumatol 2002;18(3):103–215. DOI: 10.1034/j.1600-9657.2002.00004.x.
Naudi AB, Fung DE. Tooth fragment reattachment in multiple complicated permanent incisor crown-root fractures - a report of two cases. Dent Traumatol 2008;24(2):248–252. DOI: 10.1111/j.1600-9657.2007.00526.x.
Davarpanah M, Martinez H, et al. Clinical Manual of Implant Dentistry: Contraindication for Dental Implants. St. Louis: Quintessence Publishing Co Ltd, 2003; pp. 1–20.
Wolcott J, Rossman LE. Intentional replantation of endodontically treated teeth: an update. Compend Contin Educ Dent 2003;24(1):68–72, 74.