Modified Crown Lengthening With Postcore Restoration For Crown-Root Fractures

Preservation of compromised anterior teeth in the esthetic zone presents significant clinical challenges. This case demonstrates an interdisciplinary approach for subgingival crown-root fractures, combining minimally invasive periodontal surgery with prosthodontic rehabilitation. A 22-year-old female presented with complicated crown-root fractures on endodontically treated maxillary central incisors (#11 and #21). Clinical examination revealed subgingival fracture margins (0.5-1 mm) with adequate ferrule height and stable periodontium (PD:3-4 mm). Surgical crown lengthening with a precision osteotomy (<2mm bone removal) and apically positioned flap achieved a 3mm suprarenal tooth structure, preserving alveolar architecture. After soft tissue maturation, zirconia crowns on cast post-and-cores were delivered. At 3-month recall, periodontal health (PD≤3mm, SBI<15%) and esthetic/functional outcomes were achieved. This prosthetically guided approach resolves biologic width violations through targeted osteoplasty, avoiding excessive bone loss from traditional resection. The modified flap design maintains papillary contours, critical for anterior esthetics. Compared to implant alternatives, it offers biological preservation and cost-efficiency for young patients with sound periodontal support. The protocol successfully integrates periodontal plasticity with prosthetic demands, establishing a predictable tooth-preservation strategy for subcrestal fractures. Key success factors include strict case selection (adequate root length/ferrule), controlled osteotomy depth, and prosthetic-driven margin positioning. This approach provides a biologically sound alternative to extraction, particularly for young adults prioritizing natural tooth retention. Its minimal invasiveness and esthetic predictability align with contemporary patient-centered care principles.