Long-Term Clinical Management of Recurrent Traumatic Crown–Root Fracture in a Permanent Maxillary Incisor Through Fragment Reattachment: A Three-Year Case Report and Outcome Analysis
Keywords:
Crown-root fracture, fragment reattachment, dental trauma, permanent maxillary incisorAbstract
Traumatic crown–root fractures of permanent anterior teeth represent a complex clinical challenge due to the simultaneous involvement of enamel, dentin, cementum, and, in many cases, the periodontal attachment apparatus. Preservation of aesthetics, restoration of function, maintenance of periodontal health, and prevention of recurrent fracture remain the principal objectives of treatment. Fragment reattachment has emerged as a conservative and biologically favorable treatment modality that preserves natural tooth structure while achieving acceptable esthetic and functional outcomes. Despite advances in adhesive dentistry and trauma management protocols, long-term evidence regarding recurrent traumatic crown–root fractures managed through fragment reattachment remains limited. This research and review article presents a comprehensive analysis of the long-term clinical management of a recurrent traumatic crown–root fracture in a permanent maxillary incisor treated through fragment reattachment and monitored over a three-year period. The study integrates current evidence from dental traumatology literature, evaluates biological and restorative considerations, and examines factors influencing treatment success. The article further discusses diagnostic protocols, adhesive strategies, periodontal management, follow-up assessment, and long-term outcomes associated with conservative fragment reattachment techniques. Findings indicate that successful management depends on accurate diagnosis, preservation of the fractured fragment, appropriate adhesive protocols, periodontal stabilization, and continuous monitoring. Long-term outcomes demonstrate favorable esthetic integration, functional stability, and patient satisfaction when multidisciplinary principles are applied. The study supports fragment reattachment as a viable treatment option for recurrent crown–root fractures while highlighting limitations related to fracture pattern, biological width involvement, and reinjury risk.
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1. Andreasen JO, Andreasen FM, Tsukiboshi M, Eichelsbacher F. Crown-root fractures. In: Andreasen JO, Andreasen FM, Andersson L, (eds). Textbook and color atlas of traumatic injuries to the teeth, 5th edition. Wiley Blackwell, Hoboken, NJ; 2018. pp: 230–66.
2. Bourguignon C, Cohenca N, Lauridsen E, Flores MT, O’Connell AC, Day PF, et al. International association of dental traumatology guidelines for the management of traumatic dental injuries: 1. fractures and luxations. Dent Traumatol 2020; 36:314–30.
3. Canoglu H, Gungor HC, Cehreli ZC. Management of cervical root fracture using orthodontic extrusion and crown reattachment: a case report. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2007; 104:46–9.
4. Castro JCM, Poi WR, Manfrin TM, Zina LG. Analysis of the crown fractures and crown-root fractures due to dental trauma assisted by the Integrate Clinic from 1992 to 2002. Dent Traumatol 2005; 21:121–6.
5. Cengiz SB, Kocadereli I, Gungor HC, Altay N. Adhesive fragment reattachment after orthodontic extrusion: a case report. Dent Traumatol 2005; 21:60–4.
6. de Sousa APBR, França K, de Lucas Rezende LVM, do Nascimento Poubel DL, Almeida JCF, de Toledo IP, et al. In vitro tooth reattachment techniques: a systematic review. Dent Traumatol 2018; 34:297–310.
7. Demarco FF, Fay R-M, Pizon LM, Powers JM. Fracture resistance of re-attached coronal fragments – influence of different adhesive materials and bevel restoration. Dent Traumatol 2004; 20:157–63.
8. Eden E, Yanar SC, So¨nmez S. Reattachment of subgingivally fractured central incisor with an open apex. Dent Traumatol 2007; 23:184–9.
9. Emerich-Poplatek K, Sawicki L, Bodal M, Adamowicz-Klepalska B. Forced eruption after crown/root fracture with a simple and aesthetic method using the fractured crown. Dent Traumatol 2005; 21:165–9.
10. Flores MT, Andreasen JO, Bakland LK, Feiglin B, Gutmann JL, Oikarinen K et al. International Association of Dental Traumatology Guidelines for the evaluation and management of traumatic dental injuries. Dent Traumatol 2001; 5:193–8.
11. Khandelwal P, Srinivasan S, Arul B, Natanasabapathy V. Fragment reattachment after complicated crown-root fractures of anterior teeth: a systematic review. Dent Traumatol 2021; 37:37–52.
12. Koyuturk AE, Malkoc S. Orthodontic extrusion of subgingivally fractured incisor before restoration. A case report: 3-years follow-up. Dent Traumatol 2005; 21:174–8.
13. Lokade A, Tewari N, Goel S, Mathur VP, Srivastav S, Rahul M. Comparative evaluation of fragment reattachment protocols for the management of teeth with crown-root fractures. Dental Traumatology 2022; 1:1–6.
14. Long H, Zhou Y, Ye N, Liao L, Jian F, Wang Y, et al. Diagnostic accuracy of CBCT for tooth fractures: a meta-analysis. J Dent 2014; 42:240–8.
15. Madhubala A, Tewari N, Mathur VP, Bansal K. Comparative evaluation of fracture resistance using two rehydration protocols for fragment reattachment in uncomplicated crown fractures. Dent Traumatol 2019; 35:199–203.
16. Nandlal B, Daneswari V. Restoring biological width in crownroot fracture: a periodontal concern. J Indian Soc Pedod Prev Dent 2007; 25(Suppl):S20–4.
17. Oz IA, Haytac¸ MC, Toroglu MS. Multidisciplinary approach to the rehabilitation of a crown-root fracture with original fragment for immediate esthetics: a case report with 4-year follow-up. Dent Traumatol 2006; 22:48–52.
18. Panduric V, Gabric D, Negovetic-Mandic V. Immediate posttraumatic upper incisor reconstruction using composite resin.
19. Panzarini SR, Pedrini D, Brandini DA, Poi WR, Santos MF, Correa JPT et al. Physical education undergraduates and dental trauma knowledge. Dent Traumatol 2005; 21:324–8.
20. Poi WR, de Cardoso L, de Castro JC, Cintra LT, Gulinelli JL, de Lazari JA. Multidisciplinary treatment approach for crown fracture and crown-root fracture – a case report. Dent Traumatol 2007; 23:51–5.
21. Tewari N, Tamchos R, Chaurasia B, Rahul M, Mathur VP, Goel S, et al. Comparison of three protocols for the management of refracture of teeth with uncomplicated crown fractures. Dent Traumatol 2022; 38:71–6.
22. Toshihiro K, Rintaro T. Rehydration of crown fragment 1 year after reattachment: a case report. Dent Traumatol 2005; 21:297–300.
23. Wang Z, Heffernan M, Vann WF Jr. Management of a complicated crown-root fracture in a young permanent incisor using intentional replantation. Dent Traumatol 2000; 24:100–3.
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Copyright (c) 2026 Dr. Haruki Tanaka, Dr. Mei Nakamur (Author)
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