PMC4876209_01
Preoperative photograph showing split tooth of 27.
CRID2016-5083874.002.jpg
PMC4876209_01_CRID2016-5083874.002.jpg
fig2
Intraoral examination of all quadrants revealed longitudinal fractures involving 27, 37, and 46 (Figures 2      -9). On visual inspection of 27, the fracture line was running mesiodistally involving both the marginal ridges (Figures 2 and 7). The fracture segments cannot be displaced, but they can be visualized by wedging with a probe (Figure 2).
Preoperative photograph showing fractured cusps in 37 and 46.
CRID2016-5083874.003.jpg
PMC4876209_01_CRID2016-5083874.003.jpg
fig3
Intraoral examination of all quadrants revealed longitudinal fractures involving 27, 37, and 46 (Figures 2      -9). Both fractured segments were in position but can be visualized by exploring with a probe (Figure 3).
Preoperative radiograph of 27.
CRID2016-5083874.004.jpg
PMC4876209_01_CRID2016-5083874.004.jpg
fig4
Intraoral examination of all quadrants revealed longitudinal fractures involving 27, 37, and 46 (Figures 2      -9). Fracture line was not appreciable on the radiograph (Figure 4).
Preoperative radiograph of 37.
CRID2016-5083874.005.jpg
PMC4876209_01_CRID2016-5083874.005.jpg
fig5
Intraoral examination of all quadrants revealed longitudinal fractures involving 27, 37, and 46 (Figures 2      -9). An intraoral periapical radiograph revealed intact lamina dura (Figure 5).
Preoperative radiograph of 46.
CRID2016-5083874.006.jpg
PMC4876209_01_CRID2016-5083874.006.jpg
fig6
Intraoral examination of all quadrants revealed longitudinal fractures involving 27, 37, and 46 (Figures 2      -9). Intraoral periapical radiograph revealed fracture line (Figure 6).
Extent of fracture line in 27.
CRID2016-5083874.007.jpg
PMC4876209_01_CRID2016-5083874.007.jpg
fig7
Intraoral examination of all quadrants revealed longitudinal fractures involving 27, 37, and 46 (Figures 2      -9). On visual inspection of 27, the fracture line was running mesiodistally involving both the marginal ridges (Figures 2 and 7).
Extent of fracture line in 37.
CRID2016-5083874.008.jpg
PMC4876209_01_CRID2016-5083874.008.jpg
fig8
Intraoral examination of all quadrants revealed longitudinal fractures involving 27, 37, and 46 (Figures 2      -9). It was running cervically from buccal groove towards the centre of occlusal surface and then extending mesially involving the mesial marginal ridge (Figure 8).
Extent of fracture line in 46.
CRID2016-5083874.009.jpg
PMC4876209_01_CRID2016-5083874.009.jpg
fig9
Intraoral examination of all quadrants revealed longitudinal fractures involving 27, 37, and 46 (Figures 2      -9). Further, the fracture line was extending up to the coronal third of the root surface, without involving the pulpal floor (Figure 9).
PMC4876209_02
Photograph showing stabilization of split tooth with respect to 27 using orthodontic band.
CRID2016-5083874.010.jpg
PMC4876209_02_CRID2016-5083874.010.jpg
fig10
Immediately after the diagnosis, the tooth was stabilized using orthodontic band (RMO 0.180 x 0.005 mm) (Figure 10).
Postobturation radiograph with respect to 27.
CRID2016-5083874.011.jpg
PMC4876209_02_CRID2016-5083874.011.jpg
fig11
The biomechanical preparation was done using Rotary V-Taper (30/0.04%) (SS White) (Figure 11).
Radiograph showing 3 mm of intracanal space preparation with respect to 27.
CRID2016-5083874.012.jpg
PMC4876209_02_CRID2016-5083874.012.jpg
fig12
From each canal, 3 mm of gutta-percha was removed with Peeso Reamer size-3 (Dentsply Maillefer, Ballaigues, Switzerland), and preparation was checked radiographically (Figure 12).
Photograph showing 3 mm placement of Ribbond in the canal.
CRID2016-5083874.013.jpg
PMC4876209_02_CRID2016-5083874.013.jpg
fig13
Into each of the three canals, 3 mm of Ribbond fibres was inserted and was stabilized in the root canal with the help of flowable composite (G-aenial Universal Flo, GC Corporation, Tokyo, Japan) and cured (Figure 13).
Photograph showing meshwork of fibre in the pulp chamber.
CRID2016-5083874.014.jpg
PMC4876209_02_CRID2016-5083874.014.jpg
fig14
Then, these fibres were spread on the floor of the pulp chamber and intermingled to create a meshwork for the internal reinforcement (Figure 14).
Radiograph showing internal reinforcement with Ribbond in 27.
CRID2016-5083874.015.jpg
PMC4876209_02_CRID2016-5083874.015.jpg
fig15
Temporary crown was cemented which was later replaced by metal ceramic crown (Figures 15 and 16).