180-Degree Replantation For Crown-Root Fracture: Case Report

Complicated crown-root fractures with subgingival extension present significant restorative challenges due to the difficulty in achieving adequate isolation and definitive margin placement. When surgical crown lengthening or orthodontic extrusion is contraindicated or impractical, rehabilitation of such teeth becomes considerably complex. Intentional replantation may provide a viable restorative strategy by repositioning the fracture margin supragingivally, thereby enabling a predictable and functional restoration. A healthy 15-year-old male presented after a fall, with no relevant medical or dental history. Both maxillary central incisors showed subluxation; tooth #11 had a complicated crown-root fracture with pulp exposure, and tooth #21 had an uncomplicated crown fracture without pulp exposure. The palatal fracture line on #11 extended 4 mm below the gingival margin. Initial management included repositioning and splinting of both incisors, and pulp extirpation of #11. Two weeks later, intentional replantation with 180-degree rotation was performed. Endodontic treatment and post-core crown restoration were subsequently completed. At 10-month follow-up, the tooth remained functional without complications. Intentional replantation is an effective option for managing a subgingival complicated crown-root fracture. 180-degree rotation repositioned the fracture margin coronally, allowing adequate ferrule and biologic width without additional surgery. The tooth remained functional and stable, with no adverse findings during follow-up. This approach may be considered when crown lengthening or orthodontic extrusion is not clinically feasible. 180-degree intentional replantation enabled successful restoration of a tooth with a complicated crown-root fracture that would otherwise have been unrestorable.