IADT treatment guidelines for crown-root fracture without pulp involvement

crown-root-fracture-uncomplicated4

Clinical findings

  • 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.

Radiographic findings

  • 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.

Treatment

Emergency treatment

  • 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.

Surgical extrusion

  • Removal of the mobile fractured fragment with subsequent surgical repositioning of the root in a more coronal position.

Root submergence

  • Implant solution is planned.

Extraction

  • 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.

Follow-up

  • 6-8 weeks – Clinical and radiographic examination.
  • 1 year – Clinical and radiographic examination.