Case Report of a Surgical Repositioning: Aesthetical Limitation and Solutions

The aim of this case report was to evaluate the short term clinical and radiographic findings of an injured tooth which was treated with surgical repositioning. 

Method: This report presented a case of crown-root fracture with pulp involvement of maxillary right central incisor and enamel-dentin fracture of maxillary left central incisor of a 12 years old boy. The patient referred  to our clinic one day after the trauma. Clinical and radiographic examinations revealed two oblique fraction lines of the mature maxillary right central incisor reaching under the enamel-cement junction with exposure of the pulp. The fractured parts of the tooth were removed with an elavator and a forceps. The fracture line was observed 4 mm below the enamel-cementum junction at the palatinal side. Surgical repositioning was prefered in order to apply root canal treatment immediately and able to make an aesthetic coronal restoration. After the tooth was extruded 4 mm by repositioning, it was stabilized with flexible splint for four weeks. Pulp extirpation and calcium hydroxide dressing of root canal were carried out immediately after repositioning. Definitive root canal treatment of maxillary right central incisor and restoration of maxillary right and left central incisors were accomplished 2 weeks later. After surgical clinical crown lenghtening a new aesthetical restoration was performed. 

Result: Clinical and radiographic examinations during recalls and after 1 year revealed good aesthetic  and no signs of progressive root resorption, marginal bone loss or periapical disease. 

Conclusion:

Surgical repositioning is a succesful treatment that ensure immediate root canal treatment and aesthetic restoration besides in some situations it could be an alternative method to orthodontic extrusion.