Complex crown-root fractures in the esthetic zone refer to a type of dental trauma occurring in the anterior region, characterized by concurrent fractures involving both the crown and the root, with associated pulp exposure and periodontal tissue injury. These injuries consistently exhibit critical anatomical features, including a fixed palatal fracture location below the alveolar crest, compromised residual tooth structure, and frequent encroachment of the biological width. To predict treatment outcomes, a risk assessment framework based on the restoration-tooth-periodontium interface was developed. Resistance risk was evaluated by assessing the type of residual dentin ferrule and the length of the root within the alveolar bone, while periodontal risk was assessed according to gingival phenotype and alveolar bone morphology. Based on these risk dimensions and the principles of aesthetics, stability, and minimally invasive treatment, a diagnostic classification system was established to categorize fractures into three types: favorable, intervention and high-risk. Type-specific management strategies were proposed: for favorable cases, crown lengthening combined with deep margin elevation to reduce periodontal risk is recommended; for intervention cases, orthodontic extrusion or surgical extrusion is applied to simultaneously address both ferrule deficiency and biological width violation; for high-risk cases, extraction followed by implant restoration is advised due to limited root preservation value. The presented classification enables clinicians to adopt a scientific and structured approach to treatment planning for these complex crown-root fractures in the aesthetic zone.
Humans ; Tooth Fractures/therapy* ; Tooth Root/injuries* ; Risk Assessment ; Tooth Crown/injuries* ; Periodontium ; Esthetics, Dental ; Dental Restoration, Permanent/methods*

OBJECTIVES: This study aimed to evaluate the clinical application value of in-situ crown reattachment technique combined with pulpotomy in the treatment of complicated crown-root fractures in young permanent anterior teeth. METHODS: A prospective study was conducted on 50 children with complicated crown-root fractures in young permanent anterior teeth, who were treated at the Pediatric Dentistry Department, Hospital of Stomatology, Xi'an Jiaotong University from June 2023 to June 2024. All patients underwent in-situ crown reattachment technique combined with pulpotomy. Clinical examinations, radiographic evaluations, and subjective satisfaction surveys (using a Likert scale of 1-10) were conducted at 1, 6, and 12 months postoperatively. Data were analyzed using SPSS 23.0. RESULTS: The loss-to-follow-up rate was 12% (6/50), with 44 cases completing the 12 months of evaluation. The clinical success rate was 93.18% (41/44), and the radiographic success rate was 97.73% (43/44). The subjective satisfaction scores showed a significant improvement in masticatory function from 7.03±0.52 at 1 month to 8.07±0.92 at 12 months postoperatively (P<0.05), whereas the scores for aesthetics, comfort, and quality-of-life impact showed no statistically significant differences (P>0.05). CONCLUSIONS In-situ crown reattachment technique combined with pulpotomy effectively treats complicated crown-root fractures in young permanent anterior teeth, demonstrating a high short-term clinical success rate, significantly improved masticatory function, and minimally invasive preservation of pulp vitality and root development potential. This technique provides an optimized treatment option for dental trauma in children, although its long-term efficacy requires further validation.
Humans ; Pulpotomy ; Tooth Fractures/surgery* ; Child ; Prospective Studies ; Male ; Female ; Tooth Root/injuries* ; Tooth Crown/injuries* ; Treatment Outcome ; Incisor/injuries* ; Child, Preschool

This report presents a case of a 9-year-old child with a complicated crown-root fracture of the maxillary central incisor, accompanied with a root fracture. The treatment strategy was minimally invasive, focusing on vital pulp preservation, root fracture recovery, and crown restoration. The fractured crown was reattached using resin short posts to enhance retention, resulting in aesthetic and functional restoration of the anterior teeth. A 2-year follow-up revealed favorable clinical and radiographic outcomes.
Humans ; Child ; Tooth Fractures/therapy* ; Tooth Root/injuries* ; Incisor/injuries* ; Tooth Crown/injuries* ; Post and Core Technique ; Dental Restoration, Permanent/methods* ; Maxilla

OBJECTIVE: To investigate the clinical and radiographic outcomes of 3 years after partial pulpotomy with iRoot BP Plus in immature permanent teeth with complex crown fracture and to provide refe-rence for the clinical application. METHODS: The study was prospectively designed and 104 immature permanent teeth with complex crown fracture were randomly allocated into two groups (n=52). The experiment group received iRoot BP Plus as the pulp capping agent while the control group received calcium hydroxide as the pulp capping agent. After partial pulpotomy, all teeth were clinically and radiographically assessed at the end of 1, 3, 6, 12, 18, 24, 30, and 36 months. The success rate in the two groups was evaluated to see if there was significant difference. The root canal wall thickness in the treated teeth was compared both between the groups and within the groups with those of the corresponding healthy teeth on the opposite side, in the same patient. RESULTS: Excluding those lost to follow-up, there were 44 teeth in calcium hydroxide group (8 teeth accounting for 15.4% were lost to follow up) and 45 teeth in iRoot BP Plus group (7 teeth accounting for 13.5% were lost to follow up) in the end. There was no intergroup difference in the success rate between calcium hydroxide group and iRoot BP Plus group (per-protocol analysis: 80% vs. 87%; intent-to-treat analysis: 67% vs. 75%). The non-inferiority margin was -10%. The 95% confidence interval of the difference in success rate was -8% to 22%. There was no significant difference in root development between the experimental teeth and contralateral control teeth. The thickness of upper 1/3 root canal in the iRoot BP Plus group was thinner than that in the CH group [(1.82±0.21) mm vs. (1.91±0.20) mm, P=0.047]. CONCLUSION iRoot BP Plus used in pulpotomy can effectively preserve the living pulp and promote the development of root in the young permanent teeth with complex crown fracture.
Humans ; Tooth Fractures ; Calcium Hydroxide/therapeutic use* ; Female ; Male ; Child ; Pulp Capping and Pulpectomy Agents ; Pulpotomy/methods* ; Prospective Studies ; Dental Pulp Capping/methods* ; Adolescent ; Dentition, Permanent ; Drug Combinations ; Tooth Crown/injuries* ; Root Canal Filling Materials ; Silicones

Child, Preschool ; Dental Restoration, Permanent ; Dentition, Permanent ; Humans ; Infant ; Root Canal Therapy ; Tooth Avulsion ; therapy ; Tooth Crown ; injuries ; Tooth Extraction ; Tooth Fractures ; therapy ; Tooth Injuries ; therapy ; Tooth, Deciduous ; injuries ; Tooth, Impacted ; etiology

Child ; Composite Resins ; Dental Bonding ; Dental Restoration, Permanent ; Dentition, Permanent ; Humans ; Incisor ; injuries ; Tooth Crown ; injuries ; Tooth Injuries ; therapy

OBJECTIVETo evaluate the clinical results of three bonding patterns for the reattachment of anterior fractured teeth.

METHODSThe reattachment of 59 anterior fractured teeth was performed using three bonding patterns, which were pattern A (pulp chamber concave + labial chamfer), pattern B (pulp chamber concave + lingual notch) and pattern C (pulp chamber concave + lingual notch + labial chamfer), and followed up for more than 24 months. Pattern A, B and C were 14 teeth, 14 teeth and 31 teeth, respectively. Twenty-one sectioned maxillary central incisors (obtained from patients with periodontal disease) whose edge fragments reattached using the three bonding patterns were used for the experimental study of shear bond strength, and each pattern was used in 7 teeth.

RESULTSThree reattached teeth fractured again due to another trauma, two of which was pattern B and one was pattern A. The reattachment of the remaining 56 anterior fractured teeth was successful after a follow up of mean 28.3 months. The experimental study showed that bonding pattern A and C could bear more shear stress than bonding pattern B (F = 5.161, P = 0.017).

CONCLUSIONSThe present study suggests that bonding pattern A (pulp chamber concave + labial chamfer) and C (pulp chamber concave + lingual notch + labial chamfer) were the best methods for the reattachment of fractured anterior teeth.

Adolescent ; Child ; Dental Bonding ; methods ; Female ; Follow-Up Studies ; Humans ; In Vitro Techniques ; Incisor ; injuries ; Male ; Middle Aged ; Shear Strength ; Tooth Crown ; injuries ; Tooth Fractures ; therapy

Crowns ; Humans ; Post and Core Technique ; Tooth Crown ; injuries ; Tooth Diseases ; therapy ; Tooth Root ; injuries

Humans ; Periapical Diseases ; therapy ; Periodontal Diseases ; therapy ; Tooth Crown ; injuries ; Tooth Diseases ; therapy ; Tooth Root ; injuries

OBJECTIVETo discuss orthodontic extrusion of crown-root fractured teeth before restoration.

METHODS3 cases with fractured teeth and 2 cases with root caries were performed canal therapy.

RESULTSOrthodontic extrusion of the root was carried out before restoration. All cases were satisfactory after treatment.

CONCLUSIONSOrthodontic extrusion of remaining root before restoration not only can maintain the remaining root but also obtain functional and esthetic results.

Humans ; Root Canal Therapy ; Root Caries ; therapy ; Tooth Crown ; injuries ; Tooth Fractures ; therapy ; Tooth Movement Techniques ; methods ; Tooth Root ; injuries