The Prognosis Of An Immature Central Incisor After  Consecutive Traumas

Method: A 10-year-old girl who suffered complicated crown fractures of maxillary central incisors referred to our clinic 2 years after the trauma. Calcium hyroxide apexification was the treatment of choice for the necrotic immature teeth. During the apexification treatment, she had a new trauma and a cervical root fracture on the left central incisor occured. Clinical and radiological examinations revealed an oblique fracture line which was extending labially towards the coronal third of root and the coronal segment was mobile. Removal of coronal fragment and disarticulation of radicular fragment was followed by an intentional replantation with 180° rotation. Stabilization of the root in its new position was achieved with interdental sutures which were removed 1 week postoperatively. The root canal treatment was completed with gutta-percha and the tooth was restored using glass fibre post and composite core followed by a full ceramic crown fabrication. 

Result: After  4 years of follow-up period the tooth and periodontal tissues remained healthy clinically and radiologically and an acceptable  aesthetics outcome was achieved. 

Conclusion: It could be suggested that the intentional  replantation with 180° rotation of root could be a good option for the treatment of oblique root fracture and  an acceptable level of aesthetic and function could be achieved.