Onsite Reattachment Of Complicated Crownroot Fracture Of Young Permanent Teeth

This case reports the treatment of a complicated crown-root fracture in a young permanent tooth through pulpotomy and in situ fractured crown reattachment. An 8-year-old male Complained with a fractured tooth 11 following trauma. Clinical examination revealed a palatal crown fracture extending subgingivally, grade III mobility in the distal fragment, exposed pulp, and sensitivity. CBCT showed a labio-palatal fracture line to the level of the alveolar ridge and without root involvement and an open apex. The treatment plan included partial pulpotomy, situ fragment reattachment, and restoration. Under anesthesia, the palatal gingival flap was loosened to expose the fracture site. A partial pulpotomy was performed under microscopy, removing coronal pulp 2 mm below the fracture, followed by IRoot-BP coverage, glass ionomer base, and reattachment of the fragment using 3M Relyx Ultimate Clicker. The tooth was restored with Z350 A2 resin and adjusted for occlusion. Follow-ups at 3, 6, and 12 months showed favorable outcomes. Diagnosis and treatment of complex crown-root fractures in young permanent teeth involve multiple aspects. The top priority is to preserve pulp vitality for root development, and then restore function and appearance. In this case, the distal crown fracture of tooth 11 was deep. We did pulpotomy and reattached the crown in situ. Only the palatal gingival flap was loosened for better hemostasis and less trauma. The in-situ crown reattachment technique has advantages but its long - term efficacy needs further verification due to a short observation period.