Management Of Crown-Root Fractured Maxillary Incisor By Orthodontic Extrusion

Complicated crown-root fractures of anterior teeth frequently extend subgingivally, making clinical management challenging. Orthodontic extrusion is a conservative treatment that allows supragingival exposure of fracture margins, enabling effective definitive restoration. A 34-year-old male presented with a complicated crown-root fracture of the maxillary central incisor (#11) after trauma. Clinical examination revealed fracture margins extending subgingivally. Treatment included root canal therapy, orthodontic extrusion, fiberotomy, and definitive prosthetic restoration. After fragment removal and pulp extirpation, initial endodontic procedures were completed under rubber dam isolation. Orthodontic extrusion was initiated using a clear orthodontic button and elastic traction. Due to frequent detachment of the button, the extrusion method was adjusted to maintain continuous coronal movement. Supracrestal fiberotomy was performed during extrusion to prevent gingival migration and relapse. After approximately two months of orthodontic extrusion, sufficient coronal tooth structure was obtained, and root canal obturation with gutta-percha followed by fiber post-core placement was performed. Final restoration with an all-ceramic crown was completed. At regular follow-up visits, the tooth showed no mobility, discomfort, or periodontal inflammation. Orthodontic extrusion combined with fiberotomy effectively reestablishes the biologic width, enabling predictable restorative outcomes. Controlled application of orthodontic force and periodic fiberotomy procedures are crucial in minimizing relapse risk and maintaining periodontal health. Orthodontic extrusion is a minimally invasive and predictable method for managing complicated crown-root fractures, facilitating successful restorative outcomes and improving periodontal prognosis.