497 - Crown Lengthening for a growing patient with severely fractured teeth

The preservation of a healthy periodontium is critical for the long-term success of a restored tooth. In cases of extensive caries, tooth fracture, inadequate crown length and increased esthetic demands, restorative margins need to be placed apically to the gingival margin. Violation of the biological width due to dental trauma frequently appears in clinical practice. There are three treatment options for preservation of biological width and ferrule effect; crown lengthening, orthodontic extrusion, and surgical extrusion. This case report describes the surgical intervention and fixed prostheses on crown-root fractured maxillary incisors in a growing patient.

A fourteen-year-old boy was referred from OMFS and visited the Department of Pediatric Dentistry after emergency dental treatment. He got hit with a baseball bat and his upper right central and lateral incisor were fractured with pulp exposure. A vertical fracture line extended below gingival margin on each tooth was observed. Surgical extrusion and conventional root canal treatments were performed on both fractured teeth. Surgical crown lengthening was additionally done to preserve the biological width and to make sure of the ferrule effect. Then, these teeth were finally restored with PFM crowns.

Surgical extrusion and crown lengthening might be considered as utmost treatments to save the tooth instead of the coronectomy or extraction for a severely fractured tooth. The case described here showed the satisfactory aesthetic and periodontal outcomes during two years of follow ups so far, the patient was most satisfied with that he could have his natural teeth of all things.



Identify Supporting Agency and Grant Number: Research supported by National Research Foundation of Korea (NRF) grant by the Korea government (MSIT; No. 2022R1F1A1074271).