Multidisciplinary Protocol Restores Complicated Crown-Root Fracture in Adolescent: Recent Case Report
A recent case report highlights a predictable, tooth-preserving approach for restoring complex crown-root fractures extending below the gumline. By combining root canal treatment, surgical crown lengthening, and all-ceramic crowns, clinicians can reliably save severely damaged teeth.
These findings of the case report are published in the Indian Journal of Dental Sciences by Dr. I. Kathiravan and co-authors from the Department of Conservative Dentistry and Endodontics at Indira Gandhi Institute of Dental Sciences, Puducherry.
Clinical Case Overview
Subgingival crown-root fractures present substantial restorative challenges due to biologic width violation, isolation difficulties, and structural loss. The presented report outlines trauma management in permanent maxillary incisors using cone-beam computed tomography (CBCT) guidance and conservative periodontal surgery.
Case 16-Year-Old Male
A 16-year-old male presented with traumatic dental injuries sustained from a fall 24 hours prior. Examination revealed an Ellis Class III crown fracture of tooth 11 with pulpal exposure, while tooth 12 exhibited a complicated crown-root fracture with buccal supragingival and palatal subgingival extension. Both incisors tested non-vital to thermal and electric pulp testing, with Grade II fragment mobility on tooth 12. Sagittal and coronal CBCT imaging revealed an oblique fracture line extending 2 mm apical to the alveolar crest on the palatal surface without vertical root splitting.
Immediate stabilization of teeth 11 to 13 was accomplished using a flexible 0.016-inch stainless steel wire bonded with flowable composite resin. Following rubber dam isolation, endodontic access was prepared, and mechanical instrumentation was completed using rotary nickel-titanium files up to size F3 under 2.5% sodium hypochlorite and 17% EDTA irrigation. Obturation was performed using warm vertical compaction of gutta-percha with resin sealer.
Two days post-endodontics, the splint was removed, and a mucoperiosteal flap was elevated. The fractured segment was removed, and palatal osseous recontouring was executed with carbide burs under saline irrigation to re-establish a 2 mm biologic width. Following post space preparation leaving 4 mm of intact apical gutta-percha, a glass fiber post was cemented into tooth 12 using dual-cure resin cement, followed by flap suturing. After tissue healing, full-coverage lithium disilicate ceramic crowns were fabricated with circumferential shoulder finish lines and 2 mm incisal reduction, then adhesively luted. At 1-year follow-up, the patient remained fully asymptomatic with stable periodontal health, excellent marginal adaptation, and restored function.
Implications for Clinicians
Managing complex crown-root fractures requires balancing biologic width re-establishment, endodontic obturation, and biomechanical reinforcement. Three-dimensional CBCT evaluation is critical for accurately delineating subcrestal fracture contours. Integrating surgical crown lengthening with fiber post-reinforcement and lithium disilicate crowns permits conservative tooth retention, successfully avoiding premature tooth extraction in young patients.
Reference
Kathiravan, I., Kumar, A. S., Thavithavakar, D., & Venkatapathi, A. (2026). Management of complicated crown–root fracture. Indian Journal of Dental Sciences, 18(3), 189–193.
