Crown-root fractures involve the enamel, dentine
and part of the root (cementum) surface of the tooth.
The fracture line invariably passes subgingivally. The
pulp is often exposed and endodontic therapy is
generally necessary if the tooth is to be retained. A
number of treatment alternatives are available depending
on the position and circumferential extent of the
fracture, and the severity of the fracture in a sub-gingival direction.
Treatment options were reviewed by
Moule and Heithersay
and they include: periodontal
surgery to expose crown margins, restorative
management only with extension of the margins of the
restoration below the level of the gingival margin,
orthodontic extrusion, intentional replantation
(surgical repositioning), autotransplantation, root
submergence (decoronation), extraction and replace-ment,
or orthodontic space closure. Treatment of
crown-root fractures can be complex and time
consuming. However, most teeth with these types of
fractures can be saved.
In an adult patient, implant
replacement is sometimes a viable alternative. In the
case of a growing patient with a tooth that is not
restorable, root submergence (decoronation) may be
indicated to preserve bone and allow for normal
alveolar development prior to implant placement when
growth is complete.