PMC5822811_01
Pretreatment photograph of tooth 21 with crown-root fracture (frontal view).
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Clinical examination revealed an oblique fracture from the labial surface of the upper left permanent central incisor (tooth 21) extending palatally 3.5 mm beneath the gingival margin (Figures 1 and 2).
Pretreatment photograph of tooth 21 with crown-root fracture (palatal view).
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Clinical examination revealed an oblique fracture from the labial surface of the upper left permanent central incisor (tooth 21) extending palatally 3.5 mm beneath the gingival margin (Figures 1 and 2).
Periapical radiograph of tooth 21 showing the extent of the crown-root fracture.
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A periapical radiograph showed evidence of a crown-root fracture of the tooth 21, and the tooth has an immature apex (Figure 3).
Location of the root canal treatment access on the palatal of the fractured tooth 21 after repositioning of the fractured fragments.
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An access cavity was made through the crown (Figure 4).
Root canal of tooth 21 filled with nonsetting calcium hydroxide.
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The canal was chemomechanically prepared, dried, and filled with nonsetting calcium hydroxide (Figure 5).
Obturation of the root canal of tooth 21 with bioceramics and gutta-percha.
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The following week, the canal was obturated with thermoplasticised GP, and the access cavity was restored with the self-cured GIC (Figure 6).
Sectional fixed orthodontic appliance in place for extrusion of fractured tooth 21.
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Extrusion of the fractured tooth was initiated with a sectional fixed orthodontic technique using a 0.014 x 0.025 rectangular nickel-titanium (NiTi) archwire (Figure 7).
Periapical radiograph of tooth 21 following extrusion prior to reattachment of the fractured fragment of the tooth.
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The periapical radiograph did not show any remarkable changes (Figure 8).
Final restoration of tooth 21 using the patient's own fractured fragment of the tooth.
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The stored coronal fragment was reattached to the extruded tooth with composite resin (Figure 9).
PMC5822811_02
Pretreatment photograph of tooth 11 with crown-root fracture (frontal view).
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Clinical examination showed a crown-root fracture of the upper right permanent central incisor (tooth 11) (Figure 10).
Pretreatment photograph of tooth 11 with crown-root fracture (palatal view).
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The oblique fracture line extended in a labiopalatal direction with the palatal margin extending 3.5 mm subgingivally (Figure 11).
Cone beam computed tomographic view of tooth 11 in various planes showing the extent of the fracture.
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Cone Beam Computer Tomography (CBCT) images of the tooth showed a complicated crown-root fracture, and the tooth has an almost matured root apex (Figure 12).
Obturation of the root canal of tooth 11 with bioceramics and gutta-percha.
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The following week, the canal was obturated with thermoplasticised GP, and four orthodontic brackets were placed on the labial surfaces of tooth 12 to tooth 22 (Figure 13).
Sectional fixed orthodontic appliance in place for extrusion of tooth 11.
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A short span 0.014 x 0.025 rectangular nickel-titanium (NiTi) archwire was used to extrude the tooth fractured palatal margin further gingivally (Figure 14).
Composite restoration of the fractured tooth 11 after orthodontic extrusion.
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Five months later, sufficient amount of the palatal margin of the fractured tooth was clinically visible for composite build-up (Figure 15).