If a decision is made to retain the tooth, either
permanently or as a short to medium-term measure
until the patient is practically able to have the tooth
replaced, endodontic therapy is usually necessary. This
can be complicated by difficulties in isolation and the
maintenance of a dry field due to the subgingival
position of the fracture line. If the crown fragment is
lost, isolation for endodontics is best achieved by using
a rubber dam cuff supplemented by cotton rolls in the
labial sulcus and the use of haemostatic agents, Cavit ®or
a cyanoacrylate adhesive. A single step endodontic
procedure can be carried out as a definitive treatment,
or as a temporary measure to be redone at a later date
when the situation is more under control. If the
fragment is available, it can be re-attached as an interim
measure to the remaining tooth structure using a
dentine bonding agent and composite resin. Endodontic
therapy can then be carried out in the standard manner
using rubber dam before proceeding to the next stage in
managing the fractured tooth. Failing this, a temporary
composite restoration may be placed through which
endodontic therapy can be performed.
In the young patient, the procedures may be
complicated by lack of root development. The priority
in treatment should then be development of root
maturity rather than restoration of aesthetics and
function. If root development is incomplete, and if the
fracture passes deeply subgingivally and involves most
of the crown, conservative pulp treatment should be
initiated to maintain the health of the radicular pulp
while normal root development proceeds. The canal
orifice can be temporarily sealed and a temporary
denture inserted until further root development occurs.
Subsequently, when the root is mature, standard
endodontic management can be carried out and
routine restoration undertaken. Root submergence
(decoronation) is sometimes an option in these cases.
In assessing crown-root fractures in young patients,
consideration must also be given to the fact that
continued eruption of the tooth may bring a
subgingival margin into more favourable position with-out
the need for restorative, orthodontic or surgical
intervention.