Treatment of a crown-root fracture

using a composite endodontic post

Jozef Minck and Marin Tulenko present a case report involving the
conservation of a crown-root fractured anterior tooth using internal
splinting with a composite endodontic post

Crown-root fractures occur when one or

more fracture lines encompass portions
of the crown and the root (Andreasen
JO, Andreasen FM, 1994). In most cases, a
fracture line runs from buccal-coronal to
palatal-apical into the cervical root third,
where it often takes a very abrupt course,
before it discontinues in a slight degree
towards the coronal (Figure 1).
This complicated injury presents the
practitioner with a difficult task, since
surgical, endodontic, restorative and
orthodontic treatments are necessary
to retain the tooth. In most cases, we
strive to avoid extracting the coronal Figure 2: Crown-root fracture the coronal
fragments but this comes with a number opening communicates directly with the
of disadvantages: pulp
1. Pulp extirpation must be carried out
immediately under poor
basic conditions (for example, bleeding
from the periodontium and poor
visibility)
2. The gingiva covers the apical fragment Figure 1: Typical progression of a crown-root
within a short amount of time and must fracture (Ebelseder K, Glockner K, 2000)
be removed
3. The patient has a massive aesthetic
impairment.
The best therapeutic alternative is thus
conservation of the entire tooth with the bottom line displayed the intra-coronal root canal bled heavily. Thus calcium
assistance of internal splinting (Ebelseder portion of the fracture opening (C-line) hydroxide was applied as a temporary
K et al, 1993). We use glass fibre-reinforced and the top line the intra-radicular portion filling. The root canal was then definitively
composite endodontic posts (Rebilda Post, (R-line) (Figure 3). treated during the second appointment
Voco) in our surgery for such cases. Exact reposition was carried out under (Figure 5).
local anaesthesia immediately after the The Ebelseder (1993) method of
diagnosis was made. The opening was internal splinting was carried out to secure
Case report sealed with light curing glass ionomer the refixation result, whereby the two
A 20-year-old patient presented at composite cement (Ionoseal, Voco). The fragments were connected with a glass
the surgery following an accident that coronal fragment was splinted labially fibre-reinforced composite endodontic
occurred during participation in a contact with a glass fibre strip, which was attached post (Rebilda Post, Voco) (Figure 6).
sport. The crown of the UL1 was in a to the neighbouring teeth with composite The root canal was prepared with the
supra-occlusion and proved to be very (Figure 4). This immediately provided the exception of the apical 4mm with the
mobile and sensitive. The cervical range patient with the ability to chew and it only appropriate bur. Then the endodontic post
of the crown exhibited a straight fracture slightly impaired the aesthetics. was tried in and trimmed extra-orally to
that bled slightly (Figure 2). Trepanation and pulp extirpation were the necessary length. After the
The diagnosis of a combination crown- carried out after the splinting. Definitive application of a dual-curing, self-etching
root fracture was confirmed with an X-ray, endodontic treatment was not possible adhesive (Futurabond DC, Voco), the
which showed an ill-defined ellipse. The during the first treatment, because the endodontic post was inserted in the root

36 Irish Dentist July 2011 www.irishdentist.ie


Figure 3: X-ray of the UL1 showing typical
progression
Figure 6: Rebilda Post (Voco)
canal using a twisting motion (Figure 7).
The combined labial splinting was
eliminated after the internal fixation.
Afterwards, the coronal fracture that
had been sealed with glass ionomer
cement during the initial presentation
was carefully ground out. This was then
covered with a layer of a highly aesthetic
light-curing composite (Amaris, Voco). The
treated tooth could now withstand full
chew loading and the natural aesthetic
was restored (Figure 8).
Final remarks
It is also possible to restore crown-root
fractured anteriors making partial use of
several dental disciplines. The conservation
of the entire tooth using internal splinting
www.irishdentist.ie Irish Dentist July 2011 37
Figure 4: Splinting of the fragments that
support the crowns using glass fibre strips
and composite
Figure 7: The inserted endodontic post
(Rebilda Post) (palatal view)
with composite endodontic posts, such
as Rebilda Post, is a good treatment
alternative. According to our clinical
experience, a durable and biologically
faultless restoration can be achieved with
this treatment alternative.
References
Andreasen JO, Andreasen FM (1994) Textbook
and colour atlas of traumatic injuries of the teeth.
Munksgaard, Copenhagen
Ebelseder K, Cartellieri B, Polanski R, Eskici A (1993)
Versuch der Erhaltung von Frontzhnen durch
innere Schienung bzw. Transfixation, Quintessenz
44(9): 1597-1610
Ebelseder K, Glockner K (2000) Zahnerhaltung
nach Kronen-Wurzel-Fraktur. Stomatologie 97(6):
11-14
Clinical
Figure 5: Definitive endodontic treatment of
UL1
Figure 8: The UL1 after treatment function
and natural aesthetics are restored
Dr Jozef Minck studied dentistry at the
University of Koice in Slovakia and was a
specialised assistant in the conservative
dentistry department of the 1st
Stomatological Clinic at the Koice Faculty
Hospital from 1980 to 1989. He has been a
licensed dentist in Koice since 1990 and the
director of the conservative dentistry section of
the Slovakian Dental Association since 2000.
Jozefs fields of expertise include aesthetic-
restorative dentistry, endodontics and
dental trauma. He has authored numerous
publications and given many lectures on these
topics. Contact him at jozefmin@zoznam.sk.
Dr Marin Tulenko studied dentistry at the
University of Koice in Slovakia and has worked
in Dr Mincks dental surgery since 2008. He is
a member of the young dentists section of the
Slovakian Dental Association and dedicates
his publications and lectures primarily to
the topics of aesthetic-restorative dentistry,
endodontics and dental trauma.