Multidisciplinary Treatment Of Fracture And Luxation Of Immature Permanent Teeth

The management of anterior tooth luxation with concomitant subgingival root fracture necessitates a multidisciplinary approach that considers biological, functional, and aesthetic factors. This case emphasizes the application of minimally invasive periodontal techniques combined with sequential endodontic treatments and direct restorative methods for managing complex crown-root fractures associated with tooth luxation. Furthermore, the report reviews key factors for achieving predictable outcomes. A 10-year-old patient presented with a dental injury following a bicycle fall. The diagnoses included a complex crown-root fracture with pulpitis for tooth 11, crown fracture and subluxation for tooth 21, and subluxation for tooth 22. The treatment for tooth 11 involved vital pulpotomy, repositioning, flexible splinting (from teeth 13 to 23), removal of the palatal root fragment, modified crown lengthening, and reattachment of the fractured crown. During follow-up, tooth 21 was diagnosed with pulp necrosis, prompting further endodontic treatment, including root canal therapy, apexification, and resin composite restoration. Modified crown lengthening preserves periodontal support tissues to some extent while reconstructing the biological width. Pulpotomy aids in root development, and apexification promotes root healing and growth. Crown reattachment, as a transitional restoration, contributes to the recovery of masticatory function. Managing crown-root fractures requires a thorough assessment of the pulp and periodontal tissue status, as well as the degree of root development. Treatment planning should follow a multidisciplinary team approach. The therapeutic strategy should prioritize a sequenced treatment approach focused on preserving the pulp, root structure, and alveolar bone.