J Korean Acad Prosthodont.  2012 Jul;50(3):204-209. 10.4047/jkap.2012.50.3.204.

Esthetic restoration of subgingival crown-root fractured maxillary anterior tooth using surgical extrusion

• Lee SJ
• Kim YJ
• Park YB
• Cho KS
• Chung MK

• KMID: 2000210
• DOI: http://doi.org/10.4047/jkap.2012.50.3.204

Abstract

Surgical extrusion, immediate extrusion following tooth luxation, is a method to preserve one's natural tooth and achieve esthetic restoration without additional periodontal surgery when subgingival dental caries or crown fracture occurs. A 16-year-old male was referred to the clinic from the department of operative dentistry for the esthetic restoration of maxillary left lateral incisor. Due to the crown to root fracture, the tooth was endodontically treated with a buccal crown length of 4 mm. When the palatal flap was elevated, the mesiopalatal cervical fracture area was situated 3 - 4 mm subgingivally. Crown lengthening was achieved through surgical extrusion. After 3 months of clinical observation and provisional restoration, the maxillary left central incisor was restored with all ceramic crown and obtained a satisfactory clinical result.

Keyword

Crown lengthening procedure; Surgical extrusion; Subgingival crown fracture

MeSH Terms

Adolescent
Ceramics
Crown Lengthening
Crowns
Dental Caries
Dentistry, Operative
Humans
Incisor
Male
Tooth
Tooth Avulsion
Ceramics

Figure

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  Fig. 1 A: Periapical radiograph at first visit. Pulp exposure is evident due to the crown-root fracture. Mature root apex can be observed, B: Periapical radiograph after root canal treatment.

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  Fig. 2 Preoperative clinical examination of maxillary left central incisor reveals subgingival crown fracture. A: Labial view, B: palatal view.

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  Fig. 3 Palatal view of maxillary left central incisor at palatal flap elevation. The lowest fracture line is equivalent to the alveolar bone crest.

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  Fig. 4 The tooth is extruded approximately 3 - 4 mm and fixed only by means of suture.

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  Fig. 5 1 month after surgical extrusion. A: Labial view, B: Palatal view.

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  Fig. 6 A: Remaining tooth structure was sufficient to obtain ferrule effect, requiring only resin core, B: Periapical radiograph 2 month postoperative.

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  Fig. 7 1 month after delivery of lithium disilicate all ceramic crown. A: Labial view, B: Palatal view.

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  Fig. 8 Comparison photo of Periotome (left) and elevator for anterior tooth (right). Note the smaller and thinner blade of the Periotome.

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  Fig. 9 Periapical radiograph 1 month after delivery of final prosthesis. The mesial emergency profile of the left central incisor is more convex than the right central incisor. Moreover the crown-to-root ratio of the left central incisor is 1:1.

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