PMC10332921_01
Root development stages. (a), (b), (c), (d), and (e) represent stages 1, 2, 3, 4, and 5. 1-4 = immature tooth and 5 = mature tooth. Adapted from Cvek's Figure 1.
CRID2023-5597996.001.jpg
PMC10332921_01_CRID2023-5597996.001.jpg
fig1
According to Cvek's classification, both incisors were determined to be at stage 3 of root development; with two-thirds of root length present (Figures 1 and 3).
Ellis class II fracture involving tooth #11, and Ellis class III fracture involving tooth #21.
CRID2023-5597996.002.jpg
PMC10332921_01_CRID2023-5597996.002.jpg
fig2
The patient had an Ellis III fracture in the maxillary left central incisor (tooth #21) and an Ellis II fracture in the maxillary right central incisor (tooth #11) due to a traumatic injury sustained while playing football (Figure 2).
Pre-operative radiographs of teeth #11 and #21 with Cvek's stage 3.
CRID2023-5597996.003.jpg
PMC10332921_01_CRID2023-5597996.003.jpg
fig3
The radiographic examination did not reveal any root fractures or periradicular radiolucency in the regions of teeth #11 and #21, but it did confirm an enamel-dentin fracture in the maxillary right central incisor (tooth #11; Figure 3). According to Cvek's classification, both incisors were determined to be at stage 3 of root development; with two-thirds of root length present (Figures 1 and 3).
Oral prophylaxis is followed by composite resin buildup on tooth #11, with an arrow indicating MTA with Glass ionomer cement restoration on tooth #21.
CRID2023-5597996.004.jpg
PMC10332921_01_CRID2023-5597996.004.jpg
fig4
Oral prophylaxis was performed, and the sandwich technique followed by composite buildup was carried out for tooth #11 (Figure 4). After 10 minutes, the MTA was covered with glass ionomer restorative cement (GC Gold Label II, GC Fuji II Tokyo, Japan), and the patient was discharged (Figures 4 and 5).
Post-operative immediate radiograph showing MTA on tooth #21.
CRID2023-5597996.005.jpg
PMC10332921_01_CRID2023-5597996.005.jpg
fig5
After 10 minutes, the MTA was covered with glass ionomer restorative cement (GC Gold Label II, GC Fuji II Tokyo, Japan), and the patient was discharged (Figures 4 and 5).
After 2 weeks of follow-up, asymptomatic and composite resin builds up on tooth #21.
CRID2023-5597996.006.jpg
PMC10332921_01_CRID2023-5597996.006.jpg
fig6
The glass ionomer restoration was partially replaced with a direct bonded composite restoration (Figure 6).
Six-month follow-up radiograph showing thickening of wall and lengthening of root length with faster apical closure on tooth #21 than tooth #11. Cvek's stage 4.
CRID2023-5597996.007.jpg
PMC10332921_01_CRID2023-5597996.007.jpg
fig7
Radiographs showed increased root lengths, accelerated apical closure, complete root growth, increased thickness of the root wall, and the formation of a calcified bridge above the vital pulp (Figure 7).
Radiograph demonstrating the faster progression of apical closure on tooth #21 with MTA than tooth #11 after 2 years. The patient had no symptoms. Cvek's stage 5.
CRID2023-5597996.008.jpg
PMC10332921_01_CRID2023-5597996.008.jpg
fig8
No radiolucent lesions were detected during the six-month follow-up or in subsequent examinations conducted over one to two years (Figure 8).