T-10 - Crown, Crown-root and Root Fractures, Endodontic and Restorative Aspects

Tooth fracture can occur at any age due to falls, sports, traffic accidents or foreign objects striking the teeth. The consequence of such an impact on a tooth varies from mild enamel chipping to complex crown-root fractures that require a multi-disciplinary approach. This presentation will focus on current treatment approaches for crown, crown-root and root fractures in immature and mature teeth, with emphasis on the role of minimally invasive endodontic and restorative dentistry.
The incidence of root fractures from trauma is not high, which may explain why dentists can be unsure about the best treatment approach and tend to overtreat. Teeth with root fractures often survive many years without treatment, although healing patterns may appear to be complicated, including resorption and mineralization processes. In this presentation, Marga Ree will show a variety of long-term follow-ups of root-fractured teeth, including the decision process when and how to interfere.
Crown-root fractures due to trauma usually occur obliquely from the labial to the palatal side, and therefore it’s common to see the fracture line extending to the subcrestal aspect on the palatal side. Treatment options include surgical crown lengthening, orthodontic extrusion or surgical extrusion. Surgical extrusion is a recognized treatment option, in which the tooth is surgically shifted within the socket to a more favorable position, so that the remaining tooth structure is more coronally placed. However, this technique has not been widely adopted, probably because extraction of a severely compromised tooth may be difficult to achieve in a gentle and predictable way. Regarding the restorative approach, a diversity of clinical solutions is available, varying from re-attachment of the original fragment to restoring with composite or ceramics.
Marga Ree will discuss a variety of clinical procedures to preserve traumatized teeth that would otherwise be deemed unrestorable.