Multidisciplinary approach to the treatment of an oblique crown-root fracture

This case report describes the management of an oblique crown-root fracture of the buccal cusp of the upper right first premolar. After removal of the fractured cusp, a provisional restorative build-up in this area was carried out, in order to carry out an endodontic treatment in a sterile environment. A glass fibre post and core were then constructed and over a 90-day period the tooth was extruded orthodontically by 4 mm. The periodontal fibres associated with this tooth were cut with a tiny surgical blade to help to prevent reintrusion of the tooth and achieve fine contouring of the gingival margins. The new tooth position was maintained with a retainer for a further 60 days and after a period with a provisional acrylic crown, a porcelain bonded crown was fitted. This case report demonstrates that such a multidisciplinary treatment approach to an oblique subgingival fracture is a reliable and predictable manner in which to save a tooth that would have otherwise been difficult, if not impossible, to restore with a resultant good long-term prognosis.