Download Department of Dentistry, Radboud University Medical Center

Treatment
of
teeth
with
‘hopeless’
crown-root
fractures
by
surgical
extrusion
Treatment of teeth with ‘hopeless’ crown-root fractures by surgical extrusion
Aukje Bouwman
Bouwman and
and Machteld
Machteld Siers
Siers
Aukje
Department
of
Dentistry,
Radboud
University
Medical
Center,
Nijmegen,
The
Netherlands
Department of Dentistry, Radboud University Medical Center, Nijmegen, The Netherlands
Introduction:
Restoring
a
tooth
with
a
traumatic
crown
fracture
is
usually
possible,
as
isolation
for
the
adhesive
procedure
is
straightforward.
However,
in
Introduction: Restoring a tooth with a traumatic crown fracture is usually possible, as isolation for the adhesive procedure is straightforward. However, in
crown-root
fractures
the
fracture
outline
often
extends
below
the
attachment
level,
rendering
restoration
impossible.
Surgical
extrusion
is
a
procedure
to
save
crown-root fractures the fracture outline often extends below the attachment level, rendering restoration impossible. Surgical extrusion is a procedure to save
such
teeth,
by
re-positioning
the
fracture
outline
to
a
restorable
level
such teeth, by re-positioning the fracture outline to a restorable level
Case
1:
A
21
year
old
female
fell
off
her
bike,
resulting
in
an
uncomplicated
crown
fracture
of
both
upper
lateral
incisors,
an
extrusion
of
the
right
upper
central
Case 1: A 21 year old female fell off her bike, resulting in an uncomplicated crown fracture of both upper lateral incisors, an extrusion of the right upper central
incisor
and
a
complicated
crown-root
fracture
of
the
left
upper
central
incisor.
At
the
first
endodontic
consultation
the
lateral
incisors
reacted
sensitive
to
cold,
incisor and a complicated crown-root fracture of the left upper central incisor. At the first endodontic consultation the lateral incisors reacted sensitive to cold,
but
the
central
incisors
did
not
respond.
The
left
central
incisor
had
a
deep
subgingival
fracture.
It
was
surgically
extruded
and
rotated
to
have
the
deep
distal
but the central incisors did not respond. The left central incisor had a deep subgingival fracture. It was surgically extruded and rotated to have the deep distal
fracture
margin
on
the
labial
side.
A
new
splint
was
applied
and
oral
hygiene
instructions
were
given.
After
two
weeks
root
canal
treatments
were
performed
in
fracture margin on the labial side. A new splint was applied and oral hygiene instructions were given. After two weeks root canal treatments were performed in
both
central
incisors.
After
six
weeks
the
insicors
were
built
up
using
a
direct
adhesive
technique
by
Drs.
Max
Stel
with
an
excellent
esthetic
result.
Due
to
a
preboth central incisors. After six weeks the insicors were built up using a direct adhesive technique by Drs. Max Stel with an excellent esthetic result. Due to a preexisting
open
bite
there
is
no
occlusal
loading
of
the
central
incisors.
After
finishing
the
treatment
a
new
orthodontic
retention
splint
was
placed.
existing open bite there is no occlusal loading of the central incisors. After finishing the treatment a new orthodontic retention splint was placed.
Courtesy Drs. Max Stel
Courtesy Drs. Max Stel
Case
2:
Case
2:
A
22
year
old
male
received
a
beating,
resulting
in
a
deep
subgingival
fracture
of
tooth
22.
A
pulpectomie
was
performed.
Tooth
22
was
Case 2: Case 2: A 22 year old male received a beating, resulting in a deep subgingival fracture of tooth 22. A pulpectomie was performed. Tooth 22 was
extruded
and
rotated
180
degrees
for
an
optimal
position
for
a
new
restoration.
A
root
canal
treatment
was
performed
and
after
6
weeks
the
splint
was
extruded and rotated 180 degrees for an optimal position for a new restoration. A root canal treatment was performed and after 6 weeks the splint was
removed.
The
tooth
was
asymptomatic
and
showed
limited
mobility,
and
was
restored
with
an
esthetic
composite
restoration.
removed. The tooth was asymptomatic and showed limited mobility, and was restored with an esthetic composite restoration.
Discussion
Discussion
There are
are several
several treatment
treatment options
options for
for aa deeply
deeply fractured,
fractured, unrestorable
unrestorable tooth.
tooth. The
The tooth
tooth can
can be
be extracted,
extracted, but
but as
as the
the patient
patient is
is often
often immature,
immature, permanent
permanent
There
replacement
is
problematic.
A
second
option
is
orthodontic
extrusion.
This
allows
for
retaining
pulp
vitality,
but
rotation
is
not
possible
and
it
is
a
time
replacement is problematic. A second option is orthodontic extrusion. This allows for retaining pulp vitality, but rotation is not possible and it is a time
consuming process.
process. A
A third
third option
option is
is surgical
surgical extrusion.
extrusion. During
During this
this procedure
procedure the
the root
root can
can be
be optimally
optimally positioned,
positioned, predominantly
predominantly rotated
rotated in
in order
order to
to relocate
relocate de
de
consuming
deepest
fracture
margin
towards
the
buccal
side
where
it
can
be
more
easily
restored.
An
atraumatic
luxation
of
the
tooth
and
minimal
extra-alveolar
time
are
deepest fracture margin towards the buccal side where it can be more easily restored. An atraumatic luxation of the tooth and minimal extra-alveolar time are
important to
to avoid
avoid replacement
replacement resorption.
resorption.
important
Conclusion
Conclusion
Surgical
extrusion
is
a
good
alternative
to
extraction
for
teeth
with
a
crown-root
fractures
Surgical extrusion is a good alternative to extraction for teeth with a crown-root fractures
Clinical
relevance
Clinical relevance
With
this
approach
we
can
save
teeth
previously
considered
hopeless.
The
level
of
periodontal
With this approach we can save teeth previously considered hopeless. The level of periodontal
attachment
is
preserved
which,
enhances
the
esthetic
result
of
the
restoration
and
facilitates
attachment is preserved which, enhances the esthetic result of the restoration and facilitates
uncomplicated and
and predictable
predictable implant
implant placement
placement should
should this
this become
become necessary.
necessary.
uncomplicated