ENDODONTOLOGY Volume: 26 Issue 1 June 2014 Case Report

Managment of complex crown root fracture using fibre post

- A case report
Geeta # *
Preethi S. # *

ABSTRACT
Coronal fractures of permanent dentition are the most common type of dental injury. If the original tooth fragment is
available following fracture, the natural tooth structures can be reattached using adhesive protocols. The development
and use of fiber-reinforced composite root canal posts make possible the reattachment of the crown esthetically and
reinforce the bonding of teeth fragments to the remaining natural teeth. Root fracture is one of the consequences of
dental trauma. Horizontal root fractures are unfortunate accidents that most of the times affect the maxillary central
incisors mainly in the middle third of the root nevertheless apical and coronal third fractures are also sometimes
reported. A single fracture occurs in most cases and multiple root fracture is a rare finding.This case report presents a
clinical technique of reattachment of coronal fragment of maxillary lateral incisor after trauma using direct fiber-
reinforced post systems and simultaneously management of the fracture in the middle third of the root using fibre post
as a intraradicular splint. Healing was observed at 1 year follow-up examination.
Keywords: Crown fracture, fiber post, reattachment, restoration, trauma.

Introduction restore aesthetics, and improve long term success

Fracture of anterior teeth by trauma is the most
frequent type of injury in the permanent dentition,
especially among children and adolescent affecting
up to 25% of this patient population. If the fracture
also exposes the dental pulp, it is known as the
injury fracture or Class 3 fracture (Ellis and Davey
classification). 1 The incidence of complicated
crown root fractures ranges from 2% to 13% of all
dental injuries and the most commonly involved
teeth are the maxillary central incisors 2,3.
Trauma in children and adolescents require
equal attention due to the physical and emotional
characteristics of both the patient and family alike.
Dentists are frequently encountered with managing
dental trauma and restoring fractured teeth.
Techniques that speed and simplify treatment,
rates are therefore of potential value and should be
considered.5,6
Chosack and Eildeman published the first case
report on reattachment of fractured incisor fragment
in 1964 in which complicated tooth fragment was
managed by endodontic treatment followed by a
cast post and core 1,6. The post and core were fitted
to the prepared tooth fragment and then cemented
to the remaining tooth structure. Recently, with the
advancements in the materials and bonding
techniques, this new method of retaining fractured
tooth segment is gaining popularity8,9. Root fractures
in permanent teeth are uncommon injuries and
represent complex healing patterns. Horizontal root
fractures are unfortunate accidents that most of the
times affect the maxillary central incisors mainly in

# Department of Conservative Dentistry and Endodontics, * Rajarajeshwari Dental College, Bangalore

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the middle third of the root, nevertheless apical and

coronal third fractures are also sometimes reported.
Incidence of horizontal root fractures ranges from
0.5% to 7% in permanent teeth for all traumatic
dental injuries13,16 . Mid-root fractures occur most
frequently in the upper anterior teeth due to their
position in the arch. These fractures are generally
transverse to oblique and may be single or multiple, Fig 1 Fracture supragingivally labial aspect
complete or incomplete Endodontic intervention is
required for non - healing fractures 10,11 . The
following are the treatment options carried out with
varied levels of success:

1. Root canal therapy of both segments (Ingle

and Bakland,2002). This may be indicated in fracture
cases when the segments are not separated, but
leakage from the fracture line can lead to failure.

2. Root canal treatment of the coronal segment

Fig 2 Horizontal fracture seen mid 1/3 root
only, if this segment shows no mobility (Flores et
al., 2007). This is the current recommendation,
particularly with the view that the apical segment/
nju may contain vital, healthy pulp tissue.

3. The use of an intra-radicular splint has been

recommended by Weine et al. 197114.

Case Report
A 32 year old male patient reported to the
Fig 3 After removal of fractured fragments
department of conservative dentistry and
endodontics, with complaints of fractured upper
front teeth after sustaining trauma due to accidental
fall,two days before. On examination a horizontal
fracture line was seen 3mm supragingivally at the
labial and palatal aspect of the maxillary central
incisor 11 (Fig 1). An oblique fracture with fracture
line was seen cervically extending subgingivally on
the palatal side involving the biological width in
relation to lateral incisor. (Fig 1) As the crown root Fig 4 Tooth fragment stored in saline

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 MANAGMENT OF COMPLEX CROWN ROOT FRACTURE USING FIBRE POST - A CASE REPORT

Fig 5. Working length determination

Fig 9. Post was tried in the canal

Fig 6. Master cone selection

Fig 10. Paracore dual cure resin injected into the post space

Fig 7 Obturation
Fig 11. Reattachment of fracture fragment with post

Fig 12. Immediate Post operative

Fig 8 Post space preparation involving fracture line showing reattached fractured fragment

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Fig 13. Postoperative view-palatal aspect
Fig 14. Evaluation after 1 year
Fig 15 Radiographically after 1year
ratio was less, extraction of 12 was done after duly
seeking permission from the patient. Electric pulp
test and thermal tests were performed in relation to
the 11. Negative response was observed in relation
to 11. The involved tooth showed no signs of
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GEETA, PREETHI S.
mobility. Radiographic findings show Periapical
radiolucency with respect to 11. Considering our
diagnostic tests, we found the first right Maxillary
incisor also had a Horizontal root fracture w.r.t.11
with undisplaced root fragments (fig 2) The space
between fractured segments appeared minimal. No
significant bone loss was observed. (figure 1A)
Treatment plan was root canal therapy of both
segments and intraradicular stabilization of these
undisplaced fracture fragments using fibre post
simultaneously attaching the fractured coronal
fragment which gets reinforced with the same post.
The treatment plan was accepted by the patient.
After anesthesia, mobile coronal tooth fragment was
removed(fig 3) Fragment was stored in sterile
distilled water to prevent discoloration and
dehyratation (fig 4). The working length was
determined with an electronic apex locater (Root
ZX, J.Marita Corp.Kyoto, Japan) and confirmed with
radiography.(fig 5) The gates glidden drills (Mani
Inc, Japan) were used for coronal segment of the
root canal. The root canal was enlarged to ISO size
60 at working length. 2.5% Sodium hypochlorite
was used during the preparation. The root canal
was dried with paper points (Spident, Hand Rolled,
Korea) and obturated using endodontic sealer(AH
Plus sealer) and laterally condensed with gutta perca
technique. The post spaces were prepared and was
extended beyond the fracture line with
corresponding drills to receive the fiber reinforced
post.The fibre post was checked for the fit.(fig 9)
After conditioning was done paracore dual cure
resin was injected into the canal and fibre post was
used to stabilize the undisplaced root segments After
fibre post was cured,the coronal fragment was
checked for the fit and fixed and cured with same
resin..Polishing was done with composite discs

Discussion
Preservation of the natural dentition and
restoration of the oral cavity to a normal functional
state is a primary goal in dentistry. With the tooth
stabilized, the periodontal membrane will regrow
if prior damage has not been too extensive12,13 Root
fracture is one of the consequences of dental trauma.
The treatment principles for horizontally fractured
teeth involve maintaining pulp vitality by
immobilizing the coronal segment 8,9. However, in
case of nonvital pulp endodontic treatment is
required to render the tooth aseptic. The separation
of the fragments is an important variable to fracture
healing.Immobilization of the fragments with a rigid
splint is arguable. For some authors, the rigid
splinting must be maintained for two to three
months, to provide matrix position in accordance
with principles for root healing9,10. In this case
splinting both the fragments was carried out as the
fracture line was apical to the alveolar crest level.
Post space preparation was done involving both
coronal and apical fragments leaving 4mm of apical
gutta-percha. Fractured roots that radiographically
revealed less space between the fragments after
repositioning healed more frequently with hard
tissue repair than those with more space between
the fragments14,15. Hence in this cae intraradicular
splint was attempted to approximate the fragments
for a better healing of the fracture.at the same time,
a fibre post has been used along with self cure resin
cement to reattach the coronal fragment which
gives a monobloc effect7. Here fibre post serves as
a splint as well helps to reinforce the coronal
fragment. Reis and Colleagues have shown that a
simple reattachment with no further preparation of
the tooth or fragment was able to restore only 37.1
% of the intact tooths fracture resistance 4.Early
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MANAGMENT OF COMPLEX CROWN ROOT FRACTURE USING FIBRE POST - A CASE REPORT
retrospective studies indicate that the clinical
performance of fibre post is promising and the failure
rate is 3.2% over a period for upto 4 years8 The
fibre post acted as a splint between the fractured
tooth segment and intact tooth, further reinforcing
the fractured segment. Use of fibre post in cases of
reattachment have a no. of advantages .They help
not only in conservation of tooth stucture , good
esthetics, better adhesion but also the stress
distribution is better as the modulus of elasticity is
similar to that of dentin.9
Conclusion
In this case treatment of horizontal root
fractured tooth was carried out with intraradicular
splinting using fibre post and at the same time
reinforcing the fracutred coronal segment. This case
demonstrates that intraradicular splinting is an
alternative technique for managing horizontal root
fracture and in one year follow up the results were
satisfactory. This technique may be advantageous
in certain cases.
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