Reattachment Of Anterior Teeth With Supragingivally Complicated Crown Fracture Using Fiber-reinforced Post

[Background] In dental traumatology literature, although the percentage of crown-root fracture is not high, its treatment is extremely challenging. In the early days, dueto the limitations of technology, most of the crown-root-fractured teeth are removed.With the development of acid-etch technique, bonding technology and fiber post,now we can firstly use several treatment techniques such as crown lengthening,orthodontic or surgical extrusion of the remaining tooth to expose the fracturesurface, and then repair the teeth with post-core crown, porcelain laminate veneers,adhesive composite restoration or tooth fragment reattachment. Due to the largefracture range, when we apply tooth fragment reattachment to the complicatedcrown-root-fractured teeth, the operation is very difficult and the prognosis is notsatisfied. So this technique is rarely applied in the complicated crown-root-fracturedteeth in the past.[Case Introduction] In this case, a13-year-old patient was referred to clinic fortreatment of his broken tooth. He came to the hospital after a month of trauma andsustained a tooth fracture to the maxillary right incisor. In the clinical examination,the fracture line was oblique extending in apical direction from labial to palatalsurface. The margin on palatal surface was located2mm below the free gingivalmargin.The fragment of the tooth had class III mobility and being held in position bythe periodontal ligament. The pulp of11is exposed, no exploration pain. The tooth responded painfully to percussion, with no reaction to cold, gums no exception.Radiologic examination revealed a horizontal fracture line on11, which is locatedabove the top of the alveolar ridge. The gap of mesial periodontal ligament becamelager. Root development was full, low density was located around the apical. Aclinical diagnosis of complicated crown-root fractured and chronic periapicalperiodontitis was established.The treatment plan was: removing11fragments+rootcanal treatment+gingivectomy+reattachment of11tooth fragment using fiberPost.During the treatment, use segments of orthodontic arch and spring to hold thegap of11. After root canal treatment, gingivectomy is applied to expose the fracturesurface, followed by reattachment of fragment using fiber Post by fiber post,ensuring accurate restoration of the crown. Later follow-up to observe whether11discolored or moved, the condition of occlusion and periodontal as well as periapical.[Results] Reattachment of11using fiber post restored the original shape andocclusal relationships. One year follow-up revealed no mobility of crown, no toothdiscoloration, occlusal relationships and periodontal in good condition, slightdiscoloration of resin.[Clinical significance] Reattachment of upper anterior teeth with complicatedcrown fracture using fiber post rehabs the appearance and functionality. This methodis conservative, low cost. It could be promoted in the repair of crown-root fracture ofthe anterior teeth.