MANAGEMENT OF A COMBINED INTRUSION AND COMPLICATED CROWN FRACTURE OF THE MAXILLARY CENTRAL INCISORS IN A CHILD

Year 2024, Volume: 48 Issue: 2, 90 - 98, 28.08.2024

İdil Özden , Fatma Güngör , Hilal Niyazoğlu Büşra Oruç , Hesna Sazak Öveçoğlu

https://izlik.org/JA45HM83PJ

Abstract

Intrusion represents the most severe form of dental trauma,
resulting in significant damage to the periodontal ligamentpulp
fibres. This report details the treatment of external root
resorption with intrusion and complicated crown fractures of
maxillary central incisors.
CBCT scans revealed oblique fractures in teeth 11-12,
extending 4 mm into the gingival line and involving the pulp.
The intrusion severity was classified as “severe” (8 mm). The
teeth were repositioned under sedation by surgical extrusion
and stabilised. Root canals were cleaned and filled with calcium
hydroxide within thirty days. Permanent restoration of the
fractured areas occurred after confirming tooth positions.
At the 12-month follow-up, severe external resorption was
observed. Remaining gutta-percha was removed, and calcium
hydroxide was applied for three weeks. At the second visit,
the canal lengths were assessed, and MTA was placed in all
resorbed areas and root canals. Throughout the subsequent
12-month follow-up, the teeth functioned normally without
symptoms.
The stage of root development, patient age, and degree of
intrusion are critical factors influencing prognosis. According
to IADT guidelines, complete root development and intrusion
exceeding 7 mm justified surgical repositioning. The literature
lacks definitive evidence comparing orthodontic versus surgical
approaches. Some authors advocate immediate surgical
extrusion to enhance endodontic access and aesthetics,
though caution is warranted due to potential mechanical
damage and root resorption. Surgical repositioning may have
contributed to post-endodontic root resorption. Nonetheless,
the multidisciplinary approach effectively restored function
and aesthetics in this case. After two years, clinical restoration
parameters remained satisfactory, alongside periodontal and
periapical conditions.

Keywords

Dental Trauma , External Root Resorption , Intrusion.

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