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Spontaneous Healing Of Complicated Crown-root Fractures In Children: Two Case Reports

Zhou, Z. 2022Other/Unknown

Zhou, Z. L., Gao, L., Sun, S. K., Li, H. S., Zhang, C. D., Kou, W. W., Xu, Z., & Wu, L. A. (2022). Spontaneous healing of complicated crown-root fractures in children: Two case reports. World journal of clinical cases, 10(18), 6298–6306. https://doi.org/10.12998/wjcc.v10.i18.6298

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Abstract

BACKGROUND: Complicated crown-root fracture is considered a severe dental trauma and is unlikely to heal without treatment. Usually, dentists have to remove the loose coronal fragment of the fractured tooth and treat the remaining part with multidisciplinary approaches. However, we observed spontaneous healing of fracture in two pediatric cases with a history of complicated crown-root fractures over 4 years ago. CASE SUMMARY: In case 1, a 12-year-old boy complained of pain at tooth 11 following an accidental fall 1 d ago. Clinical examination showed a crack line on the crown of tooth 11. Cone beam computed tomography (CBCT) images of tooth 11 showed signs of hard tissue deposition between the fractured fragments. The patient recalled that tooth 11 had struck the floor 1 year ago without seeking any other treatment. In case 2, a 10-year-old girl fell down 1 d ago and wanted to have her teeth examined. Clinical examination showed a fracture line on the crown of tooth 21. CBCT images of tooth 21 also showed signs of hard tissue deposition between the fractured fragments. She also had a history of dental trauma 1 year ago and her tooth 11 received dental treatment by another dentist. According to her periapical radiograph at that time, tooth 21 was fractured 1 year ago and the fracture was overlooked by her dentist. Both of these two cases showed spontaneous healing of complicated crown-root fractures. After over 4 years of follow-up, both fractured teeth showed no signs of abnormality. CONCLUSION: These findings may provide new insights and perspectives on the management and treatment of crown-root fractures in children.

Case Details

Disease Location

Tooth 21

Personal Characteristics

10-year-old girl

Clinical Characteristics

The patient fell down 1 day ago and wanted to have her teeth examined. Clinical examination showed a fracture line on the crown of tooth 21. Cbct images showed signs of hard tissue deposition between the fractured fragments. Upon reviewing a radiograph taken 1 year ago, a fracture line on tooth 21 was noticed. The tooth was stabilized with a flexible fiber splint and a mandible occlusal pad was placed for 2 weeks

Remission Characteristics

At 1-year follow up visit, tooth 21 remained stable and was responsive to pulp test. The periapical radiograph of tooth 21 revealed no signs of periapical abnormality and no significant change of the fracture line

Treatment & Mechanisms

Proposed Remission Mechanisms

It is likely that calcified tissue wound healing occurred since cbct showed deposition of radiopaque tissues between the separated fragments. In addition, both teeth exhibited response in the pulp test during the follow-up examination, which can demonstrate the reparative dentin formation and calcified tissue wound healing.

Clinical Treatment

Flexible fiber splint

Non-Clinical Treatment

Mandible occlusal pad