Management Of Crown-Root Fracture With Modified Surgical Extrusion Technique

Surgical extrusion offers a tooth-preserving approach for subcrestal crown-root fractures. This report introduces a modified technique incorporating biomaterial-assisted stabilization and 180° rotational repositioning, evaluated through a 15-month follow-up of a maxillary lateral incisor fracture. A 37-year-old male presented with a complicated crown-root fracture of the maxillary right lateral incisor following traumatic injury. Clinical and radiographic examinations identified a subgingival fracture line 3mm apical to the palatal gingival margin. Treatment involved fragment removal, single-visit root canal therapy, and intentional tooth extraction. A colloidal silver-impregnated gelatin sponge (ROEKO Gelatamp®, Coltene) was placed into the socket to stabilize the extruded tooth. The tooth was then repositioned with 180° labio-palatal rotation aligning the fracture margin with the gingival contour. A fiber-reinforced composite splint (QUARTZ SPLINT®, RTD) provided fixation for 8 weeks, followed by definitive porcelain crown restoration. Follow-up at 15 months demonstrated successful clinical outcomes with asymptomatic function and stable periodontal support. The gelatin sponge facilitated clog retention and socket support, preventing tooth displacement during splinting and acting as a scaffold to promote tissue regeneration. Its antimicrobial properties further reduce infection risks, enhancing post operative stability. The 180° rotation realigned the fracture margin while reducing extrusion demands, thereby improving biomechanical compatibility for prosthetic restoration. This modified extrusion technique effectively preserved natural tooth structure in a complex subgingival fracture, offering a functional alternative to implant therapy for anterior dental trauma.