What acute measures should be taken for traumatized, permanent teeth in which a crown-root fracture is present?
According to top dentists at Sky Dental, in the case of crown-root fractures, it must first be clarified whether the pulp has been opened. If this is not the case, the following procedure makes sense: As an immediate measure, the temporary stabilization of the moving segment by blocking it with the neighboring teeth is possible until a definitive treatment plan is available after extensive diagnostic measures. In the case of unclear findings, computed tomography can provide information on how far after apical the fracture line in the area of the root reaches and whether the alveolar process is also affected.
If the broken crown-root fragment is now removed, a direct assessment of the damage, as well as an exclusion or the presence of a pulp opening, is recognizable. If the fracture affects the coronal third of the root, a gingivectomy or sometimes even an accompanying mastectomy can represent the fracture defect in its entire extent, and restore restoration measures such as fillings or crowns can be made possible. Sometimes it is necessary to carry out endodontic treatment with subsequent pen-crown restoration despite the unopened pulp, otherwise efficient and aesthetic prosthetic rehabilitation would not be possible.
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In rare cases, orthodontic extrusion of the remaining root is recommended after a root canal treatment, provided that it has a sufficient length for a later subsequent pin-crown restoration.
The extraction of the fractured tooth (despite the pulp cavity not being directly affected) is indicated if the fracture gap protrudes deep into the root area and is therefore prognostically equivalent to a longitudinal fracture. Depending on the co-involvement or damage to the alveolar process, immediate, delayed immediate or late implantation makes sense.
If there is a crown-root fracture with the opening of the pulp cavity, the following procedure has proven successful: If root growth is not yet completed, it is essential to maintain pulp vitality. This can be done in the case of point-shaped openings of the pulp by capping with calcium hydroxide, in the case of larger defects, a partial pulpotomy with subsequent calcium hydroxide overlapping can also be helpful. However, with signs of apical periodontitis, root canal treatment is unavoidable. However, further root growth is thus terminated.
If the root growth of the fractured tooth has already been completed, root canal treatment is the means of choice for non-overlapping pulp openings.
All further therapeutic steps correspond to the previously described procedure after crown-root fractures without pulp opening.
In the case of crown-root fractures, the therapeutic procedure depends on how deep into the root of the fracture gap reaches. If possible, pulp vitality should be maintained for its further development if root growth is not completed.