Combined orthodontic, surgical, and restorative approach to treat a complicated crown-root fracture in a maxillary central incisor.

This case report shows the treatment of a severe traumatic tooth injury. For the maxillary right central incisor, the trauma was considered a complicated crown-root fracture. The level of the fracture line, the length of the remaining root segment, and the presence and condition of the tooth fragment determined the type of therapy. Traumatized teeth with fractures below the alveolar crest are often considered hopeless. As this report shows, the treatment of a complicated crown-root fracture in the esthetic region can be challenging. Orthodontic extrusion and crown-length surgery were performed to bring the fracture line above the alveolar bone crest. A multidisciplinary approach was required for complete rehabilitation of the traumatized maxillary incisor. Suggestions are made to improve treatment planning of complicated crown-root fractures.

The influence of initial mucosal thickness on crestal bone change in similar macrogeometrical implants: a prospective randomized clinical trial.

OBJECTIVE: The objective of this study was to evaluate crestal bone changes around bone- and tissue-level implants related to initial mucosal thickness. MATERIALS AND METHODS: Patients received at least 2 implants: one with the prosthetic abutment connection at the crestal bone level (MC) and one with the prosthetic abutment connection at 2.5 mm supra crestal (LC). Flap thickness measurements were taken using a periodontal probe after raising the buccal flap. Patients were divided into 2 groups according to the mucosal thickness-Group A (thickness, ≤2 mm) and Group B (thickness, >2 mm). RESULTS: Our study included 33 patients and 78 implants. Each patient received at least 1 implant of each type: Group A (MC), 17 implants, with a mean bone change of -0.6 ± 0.5 mm; Group B (MC), 20 with a mean bone change of -0.2 ± 0.4 mm; Group A (LC), 15 with a mean bone change of -0.1 ± 0.5 mm; and Group B (LC), 22 with a mean bone change of -0.2 ± 0.4 mm. A paired-samples t-test for groups A (MC) and B (MC) yielded a statistically significant difference (P = 0.003); there was no statistically significant difference for groups A (LC) and B (LC) (P = 0.518). CONCLUSION: If the initial mucosal thickness surrounding bone-level implants is more than 2 mm, there is significantly less crestal bone change compared with bone-level implants placed in initial mucosal thicknesses of 2 mm or less. This difference is not statistically significant when tissue-level implants are used and the implant-abutment connection is 2.5 mm above the crestal bone level.