This case study reports on the multidisciplinary management of a maxillary canine which sustained an unusual labial crown root fracture, resulting in a large veneer-like fragment. The canine was extruded orthodontically and the fragment was re-attached using adhesive materials. This multidisciplinary solution prevented impingement on the biological width, loss of vitality and loss of tooth structure, leading to an optimal soft and hard tissue aesthetic result. Successful clinical and radiographic results after three years were observed, despite canine protected occlusion.
Clinical Relevance: Multidisciplinary management can result in an improved prognosis of the tooth and, in time, may be the most cost-effective solution for the patient. When discussing treatment options with the patient, utilization of all dental specialties should be considered and offered to the patient.
Article
Dental trauma is common among young patients and is the biggest cause of loss of pulpal vitality.1 Crown root fractures most often occur following horizontal impact1 and can result in unpredictable restorations due to compromised tooth support, bone support and soft tissue support.2
The clinician must first decide upon the final location of the margin of the restoration. Biological width is the minimum soft tissue attachment between the base of the gingival sulcus and the alveolar crest that is necessary for a healthy existence of bone and soft tissue adjacent to a dental restoration.3 Maintaining this width is of utmost importance. Accepting a subgingival restoration impinges on the biological width, resulting in uncontrolled crestal bone resorption and apical migration of the attachment, which in turn results in the formation of a long junctional epithelium4 with an unnatural gingival contour. A subgingival restoration may also lead to plaque retention, causing gingival inflammation and hyperplasia, which may compromise the tooth further. Pulpal complications and difficulty gaining moisture control all limit the options available to the clinician and the patient, traditionally resulting in a less than ideal outcome.
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