Restor Dent Endod.  2016 Aug;41(3):210-217. 10.5395/rde.2016.41.3.210.

Esthetic enhancement of a traumatized anterior tooth with a combination of forced eruption and tooth alignment: a case report

• Kang SH
• Ha JH
• Jin MU
• Kim SK
• Kim YK

• KMID: 2346770
• DOI: http://doi.org/10.5395/rde.2016.41.3.210

Abstract

Exposing sound structure of a subgingivally fractured tooth using orthodontic extrusion is considered to be a conservative way to re-establish biologic width without sacrificing esthetics or jeopardizing periodontal support of neighboring teeth. When a misaligned tooth is traumatically involved, a more comprehensive approach combining tooth extrusion and re-alignment may be necessary for a successful restorative outcome. This case report describes a successful esthetic management of a patient with complicated crown-root fracture on the maxillary right central incisor and pre-existing malocclusion in the maxillary anterior region. Forced eruption along with re-alignment of teeth by orthodontic movement seems to allow re-positioning of the fracture line to a favorable position and correction of crowding, providing a better esthetic result.

Keyword

Complicated crown-root fracture; Comprehensive approach; Forced eruption; Interproximal reduction; Tooth alignment

MeSH Terms

Crowding
Esthetics
Humans
Incisor
Malocclusion
Orthodontic Extrusion*
Tooth*

Figure

• 

  Figure 1 Preoperative views. (a) Intraoral photograph; (b) Periapical radiograph; (c) Clinical view showing complicated crown-root fracture on the maxillary right central incisor after removal of the coronal fragment; (d) The deepest fracture site, approximately 6 mm below the cement-enamel junction at the mesiopalatal aspect.

• 

  Figure 2 Diagnostic cast. (a) Frontal view; (b) Occlusal view; (c) Right side view; (d) Left side view. The patient showed skeletal class I malocclusion with bialveolar protrusion and dentoalveolar crowding on the maxillary anterior region.

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  Figure 3 Set-up models with diagnostic wax-ups. (a) Frontal view, the maxillary right central and lateral incisors were re-aligned; (b) 45 degree occlusal view, large overjet was shown on the maxillary right central incisor due to the lack of space after re-alignment; (c) Frontal view, esthetic teeth alignment was acquired with interproximal reduction of the maxillary left central and both lateral incisors; (d) 45 degree occlusal view showing decreased overjet by re-aligning the teeth after space gaining.

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  Figure 4 Orthodontic movement. (a, b) For extrusion, a lingual button was attached to the labial surface of the maxillary right central incisor and 0.022 inch fixed pre-adjusted edgewise appliances were bonded to the rest of the teeth involved in orthodontic movement. A 0.014 inch nickel-titanium archwire was then placed for leveling and alignment of the teeth. Extrusion of the central incisor and labial movement of the lateral incisor were done with elastic threads; (c, d) After 12 weeks, approximately 4 mm of extrusion had been achieved with a good substrate for restoration, and the palatally positioned right lateral incisor was labially re-aligned. However, to open space for the maxillary right central incisor, interproximal reduction on the maxillary left central and both lateral incisors seems to be necessary.

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  Figure 5 Interproximal stripping instruments. (a) An orthostrip operated in a low speed handpiece; (b) A metal strip.

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  Figure 6 After 16 weeks of orthodontic treatment, coronal restoration with post placement and core build-up was performed on the maxillary right central incisor. (a) Periapical radiographs; (b) Photograph, frontal view; (c) Photograph, occlusal view.

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  Figure 7 After 20 weeks of orthodontic treatment and 4 week retention period, all brackets and a wire were removed. A minor discrepancy of the gingival level between the maxillary central incisors was observed, probably due to the coronal migration of connective tissue during orthodontic extrusion. (a) Frontal view; (b) Right side view.

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  Figure 8 A porcelain-fused-to-zirconia crown was constructed over the fractured tooth. An optimal soft tissue profile at the facial gingival level of the maxillary right central incisor was obtained by using a provisional crown for 1 month before final restoration. (a) Frontal view; (b) Occlusal view.

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  Figure 9 At the 5 month check-up following treatment, good esthetic, a stable crown position, and healthy periodontal tissues were observed. Neither vitality loss of the adjacent teeth nor pathologic signs from the injured tooth were present on follow-up clinical and radiographic examinations.

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