An interdisciplinary approach to treat crown-root-fractured tooth
A 26-year-old healthy female had traumatic fractured of left maxillary central incisor for 1 day. Clinical examination showed a cervical fracture with pulp exposure. For the tooth fracture, only the labial part was 1 mm above the gingival margin; all the other parts, including mesial, distal and lingual parts, were 3-5 mm subgingival. Patient presented class I occlusion relations and good oral hygiene []. Gingiva was slightly swollen and no gingival laceration was present. Further periapical radiography showed that the root canal was vacant, the fracture line was oblique, the periodontal membrane was normal and the remaining root length was about 14 mm, with no additional root fracture image on the remaining part of the root []. After full discussion with the patient about the advantages and disadvantages of the alternative treatment approaches, including immediate implant and tooth-extraction followed by fixed or removable partial denture replacement, the patient chose to preserve the remaining root and perform a multidisciplinary treatment. Then the treatment plan was divided into four phases as follow:\nRoot canal therapy was performed for left maxillary central incisor and the periapical radiography after RCT was satisfied [].\nFull mouth periodontal prophylaxis cleaning and initial periodontal therapy were done before orthodontic extrusion.\nA 0.8 mm Stainless Steel (SS) wire was cemented into the root canal space for the retention of orthodontic arch wire. The standard edge wise brackets were bonded on maxillary teeth and 0.018 × 0.025 inch Nickel-Titanium (NiTi) full arch wire (TP Orthodontics. Inc.) was engaged into maxillary brackets. A 0.2-0.3 N levelling and alignment extrusion force was applied, readjusted every 2 weeks. After 9 weeks engagement, 2 mm tooth structure was occlusally elevated with the simultaneous elevation of the surrounding periodontal bone tissue [].\nAfter 4-month retention to prevent relapse, the crown lengthening surgery including gingival flap operation, alveoloplasty and gingivoplasty were performed to create an optimal relation between the gingival and margin of restoration. During the operation, the necessary clinical crown and suitable gingiva anatomy were reserved [Figures and ].\nTwo month after the periodontal crown lengthening surgery for the proper wound healing process, prosthodontic restoration was performed. After fibre post and resin core (Tenax Fiber White, Coltene Whaledent Inc.) had been built up [], an accurately fitting provisional crown was fabricated and cemented. Tooth preparation and silicon rubber impression were made, and all-ceramic crown was fabricated by LAVA (3M ESPE).\nColour-selection was performed using a new Crystaleye Spectrophotometer (Olympus, Japan). After transferring the colour-selection picture to computer, dentist discussed the shape and shade of final restoration with the patient and finally decided to reproduce the colour by simulating the right maxillary central incisor.\nFinal restoration was cemented with RelyX Unicem resin cement (3M ESPE). Patient was satisfied with the result of prosthodontic restoration []. One year follow-up evaluation indicated the restoration and gingival profile were healthy and stable without relapse.