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*

Cemental tear is a rare and indetectable condition unless obvious clinical signs present with the involvement of surrounding periodontal and periapical tissues. Due to its clinical manifestations similar to common dental issues, such as vertical root fracture, primary endodontic diseases, and periodontal diseases, as well as the low awareness of cemental tear for clinicians, misdiagnosis often occurs. The critical principle for cemental tear treatment is to remove torn fragments, and overlooking fragments leads to futile therapy, which could deteriorate the conditions of the affected teeth. Therefore, accurate diagnosis and subsequent appropriate interventions are vital for managing cemental tear. Novel diagnostic tools, including cone-beam computed tomography (CBCT), microscopes, and enamel matrix derivatives, have improved early detection and management, enhancing tooth retention. The implementation of standardized diagnostic criteria and treatment protocols, combined with improved clinical awareness among dental professionals, serves to mitigate risks of diagnostic errors and suboptimal therapeutic interventions. This expert consensus reviewed the epidemiology, pathogenesis, potential predisposing factors, clinical manifestations, diagnosis, differential diagnosis, treatment, and prognosis of cemental tear, aiming to provide a clinical guideline and facilitate clinicians to have a better understanding of cemental tear.
Humans ; Dental Cementum/injuries* ; Consensus ; Diagnosis, Differential ; Cone-Beam Computed Tomography ; Tooth Fractures/therapy*

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

Post-and-core crown is one of the most common forms of restoration of tooth after root canal therapy (RCT). Infection control is the core objective of RCT, which is usually well realized by endodontists. However, many prosthodontists often neglect the infection control of the tooth and the maintenance of the curative effect of RCT during the process of post-and-core crown, which may lead to the failure of the final restoration. The concept of integrated crown-root treatment advocated recently requires clinicians to consider the RCT and final restoration as a whole, rather than simply divided into two parts-endodontic treatment and restorative treatment. As the core content of integrated crown-root treatment, infection control should be taken seriously by clinicians and implemented throughout the whole treatment process, especially in the restorative treatment that is easily overlooked after RCT. Therefore, this article describes the infection control of post-and-core crown restoration, classifies the tooth requiring post-and-core crown restoration, and puts forward the measures of infection control before and during post-and-core crown restoration, in order to provide reference and guidance for clinical practice.
Humans ; Crowns ; Tooth Crown ; Post and Core Technique ; Root Canal Therapy ; Infection Control ; Tooth Fractures

After teeth are replanted, there are two possible healing responses: periodontal ligament healing or ankylosis with subsequent replacement resorption. The purpose of this study was to compare the fatigue resistance of vertically fractured teeth after bonding the fragments under conditions simulating both healing modes. Thirty-two human premolars were vertically fractured and the fragments were bonded together with Super-Bond C&B. They were then randomly distributed into four groups (BP, CP, CA, BA). The BP and CP groups were used to investigate the periodontal ligament healing mode whilst the BA and CA groups simulated ankylosis. All teeth had root canal treatment performed. Metal crowns were constructed for the CP and CA groups. The BP and BA groups only had composite resin restorations in the access cavities. All specimens were subjected to a 260 N load at 4 Hz until failure of the bond or until 2 × 10⁶ cycles had been reached if no fracture occurred. Cracks were detected by stereomicroscope imaging and also assessed via dye penetration tests. Finally, interfaces of the resin luting agent were examined by scanning electron microscope. The results confirmed that the fatigue resistance was higher in the groups with simulated periodontal ligament healing. Periodontal reattachment showed important biomechanical role in bonded and replanted vertically fractured teeth.
Biomechanical Phenomena ; Humans ; Microscopy, Electron, Scanning ; Periodontal Ligament ; physiology ; Stress, Mechanical ; Tooth Fractures ; physiopathology ; therapy ; Tooth Replantation

OBJEVTIVETo evaluate the effect of different restoration methods on fracture resistance of endodontically treated teeth.

METHODSFifty intact extracted maxillary first premolars were randomly divided into 5 groups. Medial-occlusal cavity models were established in all the test groups (B-E) according to the same standard, followed by treatments with defect exposure only, defect filling with light cured composite resin, indirect resin inlays, or light cured composite resin combined with Biosplint fiber. Each specimen was tested using a universal test machine at 1.00 mm/min until fracture and the fracture load was recorded. The load angle was 45 degree to the long axis of the teeth, and the load was pointed to the middle of the lingual surface on the buccal cusp. The fracture resistance was analyzed statistically.

RESULTSThe mean load to cause fracture of the samples in each group group A to E was 1.27∓0.41, 0.23∓0.17, 0.55∓0.31, 0.89∓0.40, and 0.98∓0.34 kN, respectively, showing significant differences between the groups.

CONCLUSIONThe fracture resistance of the teeth is reduced after endodontic therapy, but can be increased significantly by restoration with composite resin inlay or light cured composite resin combined with Biosplint fiber.

Bicuspid ; physiopathology ; Composite Resins ; chemistry ; Dental Materials ; chemistry ; Dental Restoration, Permanent ; methods ; Dental Stress Analysis ; Humans ; Inlays ; Maxilla ; Tooth Fractures ; physiopathology ; Tooth, Nonvital ; physiopathology ; therapy

In the treatment of mandibular condyle fracture, conservative treatment using closed reduction or surgical treatment using open reduction can be used. Management of mandibular condylar fractures remains a source of ongoing controversy in oral and maxillofacial trauma. For each type of condylar fracture,the treatment method must be chosen taking into consideration the presence of teeth, fracture height, patient'sadaptation, patient's masticatory system, disturbance of occlusal function, and deviation of the mandible. In the past, closed reduction with concomitant active physical therapy conducted after intermaxillary fixation during the recovery period had been mainly used, but in recent years, open treatment of condylar fractures with rigid internal fixation has become more common. The objective of this review was to evaluate the main variables that determine the choice of an open or closed method for treatment of condylar fractures, identifying their indications, advantages, and disadvantages, and to appraise the current evidence regarding the effectiveness of interventions that are used in the management of fractures of the mandibular condyle.
Jaw Fixation Techniques ; Mandible ; Mandibular Condyle ; Mandibular Fractures ; Motion Therapy, Continuous Passive ; Stomatognathic System ; Tooth

Cone-Beam Computed Tomography ; methods ; Humans ; Risk Factors ; Tooth Extraction ; Tooth Fractures ; diagnosis ; diagnostic imaging ; etiology ; therapy ; Tooth Root ; injuries

Animals ; Dental Cements ; chemistry ; Glass ; chemistry ; Humans ; Materials Testing ; Post and Core Technique ; instrumentation ; Quartz ; chemistry ; Root Canal Therapy ; Tooth Fractures ; prevention & control

OBJECTIVEThe aim of the present study is to investigate the prognosis and influencing factors of crown-fractured young permanent teeth with pulp exposure.

METHODSCase records of crown-fractured young permanent teeth with pulp exposure in the Department of Pediatric Dentistry, Peking University School and Hospital of Stomatology during 1991 to 2008 with more than 2 years follow-up were collected. These patients were treated with pulpotomy at the first visit at our hospital no matter whether these teeth were treated or untreated with direct pulp capping. The age of patients, interval between trauma and treatment, root development, mobility and tenderness to percussion were recorded. The prognosis was analyzed and Logistic regression was used to analyze the influencing factors.

RESULTSTotally 118 cases satisfied the inclusion criteria, including 136 crown-fractured teeth with pulp exposure. The patients of (8.8 +/- 1.2) years old were periodically monitored for (46.1 +/- 22.0) months. The success rate of pulpotomy after pulp exposure was 85.3%. Pulp necrosis occurred in 20 teeth (25.0 +/- 19.0) months after trauma. The extent of tenderness to percussion showed significant correlation with pulp necrosis, while the age of the patients, interval between injury and treatment, and mobility of the teeth were not related to pulp necrosis.

CONCLUSIONThe success rate of pulpotomy after pulp exposure is good. Tenderness to percussion is an important signal of pulp necrosis. There are no evidence about the relationship between the patient's age, interval between injury and treatment, mobility of the pulp-exposed teeth and the pulp prognosis.

Age Factors ; Child ; Crowns ; Dental Pulp ; Dental Pulp Exposure ; Dental Pulp Necrosis ; Humans ; Incisor ; Male ; Prognosis ; Pulpotomy ; Retrospective Studies ; Root Canal Therapy ; Tooth Crown ; Tooth Fractures