Management of complicated crown fracture with an aberrantly placed tooth fragment - a case report and review of the literature Crown fracture management with tooth fragment replacement

Abstract

Background: Trauma to the anterior teeth in children is often of great concern to patients, parents and clinicians. The attendant sequelae and psychosocial impact cannot be overemphasized if the trauma is not managed properly according to international best practices for traumatic dental injuries.

Case Report: This is a case of a 15-year-old boy who presented to the paediatric clinic with a fracture of the upper left central permanent incisor and swelling of the lower lip.

On examination, the tooth was not tender to percussion, with pulpal exposure and swelling of the lower lip. A soft tissue radiograph of the lower lip showed a left-sided radiopaque mass that was suggestive of the tooth mass. Management of complicated crown fractures involves root canal treatment (RCT) and post-retained crown or composite build-up or tooth fragment reattachment if found. In this case, an RCT of the upper left central incisor was done, and surgical exposure of the tooth fragment in the lower lip was performed, followed by subsequent reattachment of the still viable tooth fragment.

Conclusion: Thorough clinical examination and radiographic assessment are the mainstays of successful diagnosis and management of dental trauma. In addition, for cases with missing tooth fragments, radiographs of the adjacent soft tissue are of high diagnostic value to rule out soft tissue impaction and tooth fragments, if found, can be successfully reattached.