Orthodontic extrusion of an incisor with a complicated crown root fracture, utilising a custom-made intra-canal wire loop and endodontic treatment: a case report with 7-years follow-up.

BACKGROUND: Dental trauma is very common among children. Crown fractures represent the majority of dental trauma in the permanent dentition. Complicated crown-root fractures require a multidisciplinary approach, for long-term success.

CASE REPORT: The multidisciplinary treatment of a traumatised permanent upper incisor of an 11-year-old patient that sustained a complicated crown root fracture, while under active orthodontic treatment is presented. The pulp was widely exposed and therefore endodontic treatment was necessary. However most of the crown (and part of the coronal part of the root as well) had been fractured and the tooth could not be properly isolated for an aseptic procedure.

METHODS: Orthodontic extrusion was decided and it was achieved using a custom-made, intra-canal wire loop that was cemented in the root canal and attached to the patients' orthodontic fixed appliances.

RESULTS: The remaining tooth structure was successfully extruded coronally and following endodontic treatment (under proper rubber dam isolation [RDI]), root canal obturated using the cold gutta-percha technique (in order to avoid further trauma to the periodontal ligament, if a warm obturation technique was chosen) and subsequently restored under RDI. At the 7-years follow-up, no signs of clinical or radiographical inflammation were evident.

CONCLUSIONS: A custom wire loop as an anchoring site is an easy-to-adopt-and-perform option for such cases. Cold gutta-percha obturation techniques should be opted for root canal obturation to avoid further trauma to the periodontal ligament.