IADT treatment guidelines for crown-root fracture without pulp involvement
- A fracture involving enamel, dentin and cementum with loss of tooth structure, but not exposing the pulp.
- Crown fracture extending below gingival margin.
- Percussion test: Tender.
- Coronal fragment mobile.
- Sensibility pulp test usually positive for apical fragment.
- Apical extension of fracture usually not visible.
- Radiographs recommended: periapical, occlusal and eccentric exposures. They are recommended in order to detect fracture lines in the root.
- As an emergency treatment a temporary stabilization of the loose segment to adjacent teeth can be performed until a definitive treatment plan is made.
Non-emergency treatment alternatives
- Fragment removal only.
- Removal of the coronal crown-root fragment and subsequent restoration of the apical fragment exposed above the gingival level.
Fragment removal and gingivectomy (sometimes ostectomy)
- Removal of the coronal crown-root segment with subsequent endodontic treatment and restoration with a post-retained crown. This procedure should be preceded by a gingivectomy, and sometimes ostectomy with osteoplasty.
Orthodontic extrusion of apical fragment
- Removal of the coronal segment with subsequent endodontic treatment and orthodontic extrusion of the remaining root with sufficient length after extrusion to support a post-retained crown.
- Removal of the mobile fractured fragment with subsequent surgical repositioning of the root in a more coronal position.
- Implant solution is planned.
- Extraction with immediate or delayed implant-retained crown restoration or a conventional bridge. Extraction is inevitable in crown-root fractures with a severe apical extension, the extreme being a vertical fracture.
- 6-8 weeks – Clinical and radiographic examination.
- 1 year – Clinical and radiographic examination.