J Korean Acad Prosthodont JKAP The Journal of Korean Academy of Prosthodontics 0301-2875 2005-3789 The Korean Academy of Prosthodontics 10.4047/jkap.2012.50.3.204 Case Report Esthetic restoration of subgingival crown-root fractured maxillary anterior tooth using surgical extrusion Lee So-Jin DDS 1 Kim Yu-Jin DDS 2 Park Young-Bum DDS PhD 1 Cho Kyoo-Sung DDS PhD 2 Chung Moon-Kyu DDS PhD 1 Department of Prosthodontics, Graduate School, Yonsei University, Seoul, Korea. Department of Periodontology, Graduate School, Yonsei University, Seoul, Korea. Corresponding Author: Moon Kyu Chung. Department of Prosthodontics, Graduate School, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Korea. +82 2 2228 3160: udprostho@yuhs.ac 07 2012 31 07 2012 50 3 204 209 06 07 2012 17 07 2012 20 07 2012 Copyright © 2012 The Korean Academy of Prosthodontics 2012

Surgical extrusion, immediate extrusion following tooth luxation, is a method to preserve one's natural tooth and achieve esthetic restoration without additional periodontal surgery when subgingival dental caries or crown fracture occurs. A 16-year-old male was referred to the clinic from the department of operative dentistry for the esthetic restoration of maxillary left lateral incisor. Due to the crown to root fracture, the tooth was endodontically treated with a buccal crown length of 4 mm. When the palatal flap was elevated, the mesiopalatal cervical fracture area was situated 3 - 4 mm subgingivally. Crown lengthening was achieved through surgical extrusion. After 3 months of clinical observation and provisional restoration, the maxillary left central incisor was restored with all ceramic crown and obtained a satisfactory clinical result.

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A: Periapical radiograph at first visit. Pulp exposure is evident due to the crown-root fracture. Mature root apex can be observed, B: Periapical radiograph after root canal treatment.

Preoperative clinical examination of maxillary left central incisor reveals subgingival crown fracture. A: Labial view, B: palatal view.

Palatal view of maxillary left central incisor at palatal flap elevation. The lowest fracture line is equivalent to the alveolar bone crest.

The tooth is extruded approximately 3 - 4 mm and fixed only by means of suture.

1 month after surgical extrusion. A: Labial view, B: Palatal view.

A: Remaining tooth structure was sufficient to obtain ferrule effect, requiring only resin core, B: Periapical radiograph 2 month postoperative.

1 month after delivery of lithium disilicate all ceramic crown. A: Labial view, B: Palatal view.

Comparison photo of Periotome (left) and elevator for anterior tooth (right). Note the smaller and thinner blade of the Periotome.

Periapical radiograph 1 month after delivery of final prosthesis. The mesial emergency profile of the left central incisor is more convex than the right central incisor. Moreover the crown-to-root ratio of the left central incisor is 1:1.