5-Year Minimal Care For Complicated Young Crown-Root Fractures

To evaluate the long-term efficacy of in situ tooth fragment reattachment combined with pulpotomy for treating complicated crown-root fractures in young permanent anterior teeth. A case of a complicated crown-root fracture (Andreasen Class II) in the maxillary right central incisor (tooth 11) of a 10-year-old patient was reported. The fracture line extended obliquely from approximately 2 mm above the gingival margin on the labial surface to the subgingival area on the palatal side, with pulp exposure and an open apex. A two-step protocol was performed: Pulpotomy (palatal access, removal of coronal pulp 3 mm below the fracture line, iRoot BP Plus pulp capping, and glass ionomer base placement); In situ fragment reattachment (preservation of the palatal fragment and natural periodontal seal, labial bevel preparation at the fracture line, and dual-cure resin bonding for both supragingival and intrapulpal fracture surfaces). Five-year follow-up assessed reattached fragment stability, pulp vitality, and root development. At 5-year follow-up, the reattached fragment remained intact without displacement, with slight discoloration and healthy gingiva. Radiographs revealed dentinal bridge formation and completed root development in tooth 11. Normal occlusal function and high patient satisfaction were achieved. In situ fragment reattachment combined with pulp preservation enables biological reconstruction of young permanent teeth with complicated crown-root fractures through minimally invasive procedures. This approach promotes root development, restores partial function, and provides a transitional solution until definitive adult restoration, offering a conservative and pulp-preserving strategy for pediatric patients.