PMC6710939_01
Patient's anterior tooth no. 21 showing vertical fracture and step deformity of the coronal fragment
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F1
Periapical radiograph of the permanent left central incisor showing open apex, vertical fracture involving enamel, dentin, and pulp and extending up to 3 mm above the cervical line
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F2
Patient's anterior tooth on the removal of the coronal fragment
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F3
On removal, there was a direct access to the pulp chamber without advocating an access cavity preparation and bleeding from the canal was seen (Figs 3 and 4).
Patient's anterior tooth on the removal of the coronal fragment (posterior view)
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F4
On removal, there was a direct access to the pulp chamber without advocating an access cavity preparation and bleeding from the canal was seen (Figs 3 and 4).
Patient's anterior tooth (no. 21) after stabilizing the coronal fragment
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F5
The fractured segment was carefully approximated with the help of fingers and repositioned and stabilized (Fig. 5) using the light cure glass ionomer cement (Fuji II Light cure Glass ionomer cement, GC Corporation, Tokyo, Japan).
Periapical radiograph taken after stabilizing the coronal fragment
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F6
A radiograph was taken immediately and a close approximation of the fractured segment was observed (Fig. 6).
Mineral trioxide aggregate placement at the cervical level after the blood clot was formed
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F7
After 15 minutes, MTA (Dentsply) was carefully placed over the blood clot followed by a wet cotton pellet and an intermediate restorative material was placed and sealed with the glass ionomer cement (Fig. 7).
3-month follow-up showing early stages of apexogenesis
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F8
At the third month recall, the patient was asymptomatic, and the radiograph showed normal periodontal findings (Fig. 8).
Detachment of coronal fragment after the second fall (anterior view)
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F9
Clinically, the access cavity was seen intact and covered with resin restoration (Figs 9 and 10).
Detachment of coronal fragment after the second fall (posterior view)
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F10
Clinically, the access cavity was seen intact and covered with resin restoration (Figs 9 and 10).
Acrylic crown cemented on tooth no. 21
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F11
The acrylic crown was delivered after 1 week (Fig. 11) and the patient was informed that acrylic crown would be replaced with the permanent crown if the tooth became symptomatic at a later stage, then would require endodontic intervention.
6-month follow-up showing continued apexogenesis
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F12
Apical closure and dentinal wall thickening were evident along with the attainment of root length (Figs 12 and 13).
1-year follow-up showing continued apexogenesis and dentinal wall thickening
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F13
Apical closure and dentinal wall thickening were evident along with the attainment of root length (Figs 12 and 13).