PMC4471325_01
(a) Intraoral buccal view of a crown-root fracture. (b) Intraoral occlusal view of a crown-root fracture. (c) Preoperative intraoral radiograph showing the extension of the fracture. (d) View of the remaining root fragment after the removal of the coronal fragment. (e) View of the extracted coronal fragment.
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The clinical examination revealed a complicated crown-root fracture of the right permanent maxillary lateral incisor with a mobile coronal tooth fragment that extended subgingivally in the buccal area (Figures 1(a)-1(b)). A radiographic examination showed that residual calcium hydroxide paste existed in the root canal and the fractured tooth had a mature apex (Figure 1(c)). Under local anesthesia, the coronal fragment was gently extracted (Figures 1(d)-1(e)).
(a) Exposing the fracture line surgically. (b) Retraction cord application. (c) Grooves created on the coronal fragment. (d) Reattachment of the coronal fragment with a dual-cure luting composite. (e) Checking the adaptation of the resin fiber post into the root canal. (f) Intraoral view of the 1-week follow-up exam after reattachment. (g) Intraoral view of the 24-month follow-up exam after reattachment. (h) Periapical radiograph of the 24-month follow-up exam showing no pathologic alteration. Notice the grooves in the coronal fragment (arrows).
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Subsequent to the canal obturation, a flap surgery was performed to make the fractured root face visible (Figure 2(a)). A retraction cord impregnated with 25% aluminum chloride retraction solution (Viscostat Clear, Ultradent, South Jordan, UT, USA) was placed on the fractured tooth borderline to control the sulcular hemorrhage (Figure 2(b)). At the same time, retention grooves were created on the coronal fragment with a round diamond bur (Figure 2(c)), and acid etching (Vococid, Voco, Cuxhaven, Germany) was applied to the enamel of the coronal fragment. Bond, Kuraray, Osaka, Japan) was applied to both the coronal and root fragments. By using a dual-curing luting composite (Variolink N, Ivoclar, Vivadent, Schaan, Liechtenstein), the coronal fragment was reattached to the root fragment and then polymerized (Figure 2(d)). The flap was then reapproximated to its original position and esthetically sutured (Figure 2(e)). The post was placed at the length of 11 mm and was stabilized into the canal with a dual-curing luting composite (Variolink N, Ivoclar) (Figure 2(e)). At the end of the follow-up visits, the clinical and radiological investigation of the tooth revealed that the tooth was asymptomatic, functional, and esthetically acceptable with no evident clinical signs and no periapical pathology (Figures 2(f)-2(h)).