Orthodontic and prosthodontic reatment of subgingival fractures of single-root teeth – a case study

Abstract

Introduction. Combined orthodontic and prosthodontic treatment usually consists of three stages: pre-orthodontic, orthodontic and prosthodontic treatment. This study discusses the orthodontic and prosthodontic treatment stages of subgingival fractures of single-root teeth. The treatment is presented on the basis of the case involving the subgingival fracture of the upper right canine tooth in a 25-years old patient. Aim. The aim of this study is to present the results of the treatment involving the improvement in the function and aesthetics of the upper jaw, following the fracture. We focused specifically on the creation of proper conditions to implement an interdisciplinary treatment. The priority of such treatment is to uncover the contour of the fractured root. The success of the treatment depends on the degree of fracture confirmed by X-ray examinations, the length of the undamaged part of the root remaining in the bone and its anatomical structure. These factors influence the result of the endodontic treatment and the following prosthodontic restoration. Materials and methods. It is possible to uncover the contour of the fractured root by means, among others, of the application of a special orthodontic technique called extrusion. In the case of the treated patient, extrusion was performed by a fixed orthodontic device placed on the neighbouring teeth and a hook cemented in the canal of the fractured tooth. The extrusion was additionally supported by cutting periodontal fibres gradually. The orthodontic treatment involved 6 appointments and lasted 6 weeks from the placement of the fixed orthodontic device till the stage when the entire contour of the root’s bearing surface was revealed. Correct orthodontic therapy was necessary for a subsequent, successful, prosthodontic reconstruction. The prosthodontic treatment lasted 1 week and involved 2 appointments. It was performed in two stages: first, crown and root inlay was made of gold alloy (87%) and then, an aesthetic crown made of gold and porcelain (galvanic technique). Results and discussion. As a result of the combined treatment, it was possible to uncover the fractured root 2 mm above the bone plate of the alveolar process, and, consequently, to recreate the damaged tooth by means of a prosthodontic reconstruction. Conclusions. Combined orthodontic and prosthodontic treatment determines a successful prosthodontic reconstruction, thus restoring the function and aesthetic effect of the upper jaw and the whole oral cavity in a relatively short period of time.