combination of ortho endo and prosthodontic in t/t of fractured teeth

1. Australian Dental Journal 2004;43:(1):28-31

2.  Fracture of a tooth below the gingival attachment
or crest of the alveolar bone presents a very difficult
restorative problem.
 Fractured teeth are often considered hopeless and are
extracted.
 Crown lengthening procedures (electrosurgery of the
gingival margins or periodontal surgery) are
attempted.

3.  Orthodontic extrusion, also referred to as forced
eruption, has been suggested as an alternative to
periodontal crown lengthening which involves the
removal of supporting alveolar bone and can
compromise aesthetics.

4.  A 10 year old boy came to the dental clinic 20
hours after he had fallen and injured his upper
anterior teeth.

5. CLINICAL EXAMINATION:
 Laceration of the upper lip with moderate oedema.
 The maxillary left central incisor had a transverse
fracture of the crown.
 The maxillary right central incisor and left lateral
incisor also had fractures of their crowns.

6.  Radiographic examination verified the presence of the
fracture of the maxillary left central incisor.

7.  The mobile crown portion was removed.

8.  The remaining portion of the tooth (the root portion)
was below the alveolar crest.

9.  Root canal therapy was carried out immediately to the
maxillary left lateral incisor. A root canal filling was
performed on the maxillary left central incisor.
Calcium hydroxide dressings were placed as apical
root formation was not yet complete. It was
decided to extrude the tooth orthodontically.

10.  A screw post was cemented to the fractured tooth.
 Elastic thread was applied from the screw post to the
specially designed vestibular arc of the Hawley
appliance for the extrusion of the tooth.

12.  The patient was examined every four days to check and
reactivate the elastic thread.

13.  Both clinically and radiographically there was clear
evidence of about 5 mm extrusion of the tooth(root).

14.  Approximately six weeks later the active treatment was
ended. There were no complications during or after
the orthodontic treatment.

15.  After completion of the extrusion, a post core was
performed.

16.  The tooth was restored with a veneer crown
constructed over the post core.
 The fractured incisal portion of the right central
incisor was restored with a composite resin using the
acid etch method.
 The fractured maxillary left lateral incisor was restored
with a jacket crown.

18.  The patient was examined two years after treatment.
The stability of the crowns can be seen clinically and
radiographically.

19.  An interdisciplinary approach to treatments of routine
dental problems has been recognized for a long time.
endodontist, an orthodontist, and a prosthodontist
participated in the dental management of a patient
with a subgingivally fractured maxillary permanent
left central incisor. It is clear that without such
cooperative action the prognosis would not have been
good.

20.  In many cases, forced orthodontic eruption provides a
useful alternative to extraction or extensive
periodontal surgery. Adjacent teeth need not be
prepared for fixed prostheses and alveolar bone is
conserved.

21.  CASE REOPRT BY: Ilken Kocadereli, DDS, PhD
 Fugen Tasman, DDS
 Sibel Bashan Guner, DDS, PhD