Crown/Root Fracture

Image: Fractured tooth with and cementum fracture.
Image: Root fracture.

A crown root fracture is a result of an enamel, dentin, and cementum fracture with or without pulp exposure. Clinical findings usually reveal a mobile coronal fragment attached to the gingiva with or without a pulp exposure. The fracture usually starts in the middle of the facial portion of the crown and extends to below the gingival level palatally. In the anterior region the coronal portion extends in an incisal direction resulting in pain upon occlusion. In the posterior region the fracture is usually confined to the buccal cusps. Root fractures can only be diagnosed radiographically. Radiographic findings may reveal a radiolucent oblique line that consists of crown and root structure in a vertical direction in primary teeth and in a direction usually perpendicular to the central radiographic beam in permanent teeth.

The treatment objectives are to maintain pulp vitality and restore normal esthetics and function. Treatment consists of:

  • Primary teeth: When the primary tooth cannot be restored, the entire tooth should be removed unless retrieval of the apical fragments may result in damage to the permanent tooth. The remaining fragments may be left to resorb normally. Follow up is clinical observation and radiograph after three to four weeks.

  • Permanent teeth: If definitive treatment cannot be performed at the initial visit, the emergency treatment is to reposition the coronal fragment and temporarily splint it to the adjacent teeth with composite for up to four weeks to reduce patient discomfort. Definitive treatment alternatives are to remove the coronal fragment followed by a supragingival restoration or necessary gingivectomy; decoronation, extraction or surgical or orthodontic extrusion to prepare for restoration. If the pulp is exposed, pulpal treatment alternatives are pulp capping, pulpotomy, and root canal treatment.

The prognosis of teeth with crown/root fractures is dependent on the location of the fracture and the extent of the enamel, dentin, cementum and pulp involvement. Fractures extending significantly below the gingival margin may not be restorable. Follow up treatment is splint removal by four weeks. In the primary dentition, follow up is clinical and radiographic examination at three to four weeks, and one year. In the permanent dentition follow up is at six to eight weeks and one year.