Korean J Orthod.  2014 Jul;44(4):217-225. 10.4041/kjod.2014.44.4.217.

Interdisciplinary rehabilitation of a root-fractured maxillary central incisor: A 12-year follow-up case report

• Alessandri Bonetti G
• Incerti Parenti S
• Ciocci M
• Checchi L

• KMID: 2273278
• DOI: http://doi.org/10.4041/kjod.2014.44.4.217

Abstract

Single-tooth implantation has become a common treatment solution for replacement of a root-fractured maxillary incisor in adults, but the long-term esthetic results can be unfavorable due to progressive marginal bone loss, resulting in gingival recession. In this case report, a maxillary central incisor with a root fracture in its apical one-third was orthodontically extruded and extracted in a 21-year-old female. Implant surgery was performed after a 3-month healing period, and the final crown was placed about 12 months after extraction. After 12 years, favorable osseous and gingival architectures were visible with adequate bone height and thickness at the buccal cortical plate, and no gingival recession was seen around the implant-supported crown. Although modern dentistry has been shifting toward simplified, clinical procedures and shorter treatment times, both general dentists and orthodontists should be aware of the possible long-term esthetic advantages of orthodontic extrusion of hopelessly fractured teeth for highly esthetically demanding areas and should educate and motivate patients regarding the choice of this treatment solution, if necessary.

Keyword

Single-tooth implants; Orthodontic extrusion; Interdisciplinary treatment; Root fracture

MeSH Terms

Adult
Crowns
Dental Implants, Single-Tooth
Dentistry
Dentists
Female
Follow-Up Studies*
Gingival Recession
Humans
Incisor*
Orthodontic Extrusion
Rehabilitation*
Tooth
Young Adult

Figure

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  Figure 1 Pretreatment intraoral photograph.

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  Figure 2 Pretreatment periapical radiograph. Note the horizontal root fracture of the left central incisor and the circular radiolucency around the apex of the adjacent lateral incisor.

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  Figure 3 A periapical radiograph that was obtained after the lateral incisor had endodontic treatment. Moreover, note that a hand file was cemented into the root canal of the central incisor before orthodontic extrusion.

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  Figure 4 Orthodontic extrusion of the root-fractured central incisor: clinical (A) and radiographic (B) views after bracket placement and elastic chain application; clinical (C) and radiographic (D) views after adoption of a multiple-loop design orthodontic appliance.

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  Figure 5 After a 4-month orthodontic extrusion, followed by a 3-month retention phase: clinical (A) and radiographic (B) views after appliance removal.

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  Figure 6 Clinical (A) and radiographic (B) views after tooth extraction and cementation of a Maryland bridge on the teeth adjacent to the extraction site.

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  Figure 7 Intraoral frontal view (A) and periapical radiograph (B) obtained after placement of implant and its final metal-ceramic crown.

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  Figure 8 Intraoral frontal view (A) and periapical radiograph (B) obtained at 6-year follow-up.

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  Figure 9 Intraoral frontal view (A) and periapical radiograph (B) obtained at 12-year follow-up.

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  Figure 10 Cone-beam computed tomography images were obtained at the 12-year follow-up: axial (A) and sagittal (B) views show the presence of a well-represented buccal cortical plate.

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  Figure 11 Graphical representation of the cross section of the root-fractured maxillary central incisor before and after orthodontic extrusion: (A) frontal view; (B) axial view at the level of the cementoenamel junction of the adjacent central incisor.

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