A Lifeline for a Hopeless Tooth - A Multidisciplinary Approach

Abstract

Restoration of traumatic teeth with complicated crown root fracture poses many challenges to the clinicians. When the fracture line is below the level of gingiva, the prognosis of such fractured tooth is considered questionable or hopeless. Treating such cases is also challenging as they are associated with loss of ferrule and compromised biological width. Preservation of such diseased natural teeth usually involves a multi-disciplinary approach involving endodontic therapy, periodontal crown lengthening and / or orthodontic extrusion followed by prosthetic rehabilitation. Tooth injuries and complicated tooth fractures especially in the aesthetic region pose a great challenge to the clinician.1 When the fracture line extends at or below the level of cement enamel junction, the prognosis of such tooth is considered questionable or hopeless; they are usually associated with the loss of ferrule and compromised biological width, and therefore restoration of such teeth becomes a great challenge. To ensure functional longevity, endodontically treated teeth with less coronal structure must have at least 5 mm of tooth structure coronal to the crestal bone. Three milli meters of tooth structure is needed to maintain a healthy soft tissue complex, and 2 mm of coronal tooth structure incisal to the preparation finish line is necessary to ensure structural integrity.2 There are mainly two reasons why a tooth extraction should be avoided: Structural reasons and psychological stress associated with extraction. Psychological stress can be in the form of financial stresses associated with extraction and rehabilitation of the same and fear of post-traumatic pain. Extraction of tooth is also followed by aesthetic challenges as it may lead to hard and soft tissue resorption as the healing architecture is unpredictable. In this case report a simple yet effective treatment is presented for a 21-year-old female patient with a chief complaint of clinical tooth fracture in relation to 44. After thorough clinical and radiographic examination, it was decided to reinforce the use of flexible glass fibre post and incorporate the same as tags to engage E chain to facilitate orthodontic tooth extrusion followed by prosthetic rehabilitation. The purpose of this case report is to describe the use of a simple chair side technique for a tooth fractured at the level of cementoenamel junction (CEJ) with forced tooth eruption.