Management of Crown-Root Fractures in Permanent Teeth
Crown-root fractures in permanent teeth do not require splinting according to standard management protocols; instead, the fractured crown fragment must be removed first, followed by assessment and potential orthodontic extrusion or other restorative procedures. 1
Initial Management Algorithm
Remove the crown fragment immediately to assess the health and viability of the remaining root structure. 1 This is the critical first step that distinguishes crown-root fractures from simple root fractures.
Key Distinction from Root Fractures
It's essential to understand that crown-root fractures are managed differently than isolated root fractures:
- Root fractures (without crown involvement) require splinting for 4 weeks, particularly when the fracture is closer to the crown 1
- Crown-root fractures require fragment removal as the primary intervention, not splinting 1
Treatment Options After Fragment Removal
Once the crown fragment is removed, evaluate the remaining root fragment for these options:
Option 1: Orthodontic Extrusion and Restoration
- Orthodontically extrude the remaining root fragment if sufficient healthy tooth structure remains 1
- Following extrusion, perform root canal therapy on mature roots 2
- Restore with a full-coverage crown after adequate tooth structure is exposed 1
- This approach preserves the natural tooth and maintains alveolar bone 1
Option 2: Root Submersion
- Submerge the remaining root to maintain alveolar bone volume for future implant placement 1
- This is particularly useful when the remaining fragment is insufficient for restoration but bone preservation is desired 1
Option 3: Temporary Esthetic Management
- Replace the missing crown with an orthodontic retainer containing a prosthetic tooth 1
- Alternatively, create a temporary bridge using the original crown fragment for esthetics and space maintenance 1
Pulpal Management Considerations
Immediate pulp therapy is required if pulpal tissue is exposed to preserve pulp vitality, especially in immature teeth. 1, 2
- For immature permanent teeth (within 3 years of eruption): Monitor for continued root development and absence of pulpal necrosis 1, 2
- For mature roots: Root canal therapy is the treatment of choice 1, 2
- Timing is critical—the sooner pulp therapy is rendered, the better the prognosis for pulp preservation 1, 2
Common Pitfalls to Avoid
- Do not attempt to splint crown-root fractures as you would with simple root fractures—the crown fragment must be removed first 1
- Do not delay fragment removal, as this prevents proper assessment and increases risk of pulpal contamination 1
- Do not confuse crown-root fractures with root fractures alone—the management protocols are fundamentally different 1
- Delaying pulp therapy when pulp is exposed leads to pulpal necrosis and compromises long-term prognosis 3
Follow-Up Monitoring
Monitor all treated crown-root fractures for signs of complications:
- Crown discoloration 1
- Gingival swelling 1
- Increased tooth mobility 1
- Development of sinus tract (parulis) 1
- Root resorption or ankylosis 1
If any of these symptoms develop, immediate dental follow-up is required to determine need for additional treatment. 1