An Interdisciplinary Periodontal Approach to the Esthetic Rehabilitation of a Complicated Crown-root Fracture: A Case Report

Abstract

Background: Complicated crown–root fractures of anterior teeth present a clinical challenge when the fracture line extends subgingivally because access, isolation, biological width maintenance, and definitive restoration become difficult. A coordinated periodontal, endodontic, and restorative approach may preserve the affected tooth while achieving acceptable function and aesthetics. Case presentation: A 24-year-old female patient presented with a fractured maxillary anterior tooth following a fall. Clinical and radiographic examination revealed a complicated crown–root fracture involving tooth #12, with the fracture margin extending below the gingival level. The fractured coronal fragment was carefully removed and stored in sterile normal saline. Endodontic treatment was performed, followed by post-space preparation. Because the fracture margin was subgingival, periodontal crown lengthening was planned using a diagnostic cast and an acrylic surgical stent to guide soft-tissue contouring and access to the remaining sound tooth structure. After crown lengthening, a fibre-reinforced composite post was luted, and core build-up was completed using composite resin. The fractured fragment was reshaped and reattached using an adhesive technique to restore tooth form during treatment. Following periodontal healing, definitive rehabilitation was completed with an adhesively cemented lithium disilicate crown. The patient was reviewed at 1 month, 3 months, and at 6-month intervals thereafter, with satisfactory healing and restoration stability. Conclusion: This case demonstrates that a multidisciplinary approach combining endodontic therapy, periodontal crown lengthening, fibre-post reinforcement, adhesive fragment reattachment, and definitive ceramic restoration can be a conservative treatment option for selected complicated crown–root fractures. Careful case selection, biological width management, adhesive protocol selection, and follow-up are essential for predictable functional and aesthetic outcomes.