Coronal Scaffold Stabilization for Conservative Management of Complicated Crown Fractures

Abstract

Background: Management of complicated crown fractures involving multiple mobile coronal fragments is clinically challenging, particularly when conventional fragment reattachment is not feasible. Removing residual fractured segments may further compromise an already weakened tooth and adversely affect the restorative prognosis. Preservation and adhesive stabilisation of multiple retained mobile coronal fragments may provide a conservative alternative by converting unstable residual tooth structure into a stable coronal scaffold that facilitates subsequent rehabilitation. Case Presentation: This case series describes the management of two permanent maxillary central incisors with complicated crown fractures using preservation and adhesive stabilisation of residual coronal fragments before definitive treatment. Case 1 involved a mature permanent incisor with a closed apex, in which stabilisation of the retained fragments facilitated conventional root canal treatment followed by full-coverage crown rehabilitation. Case 2 involved an immature permanent incisor with an open apex, in which stabilisation of the residual coronal structure enabled mineral trioxide aggregate (MTA) apexification and subsequent restoration. In both cases, preservation of the remaining tooth structure facilitated endodontic and restorative procedures while maintaining coronal integrity. Results: Both teeth were rehabilitated successfully with satisfactory aesthetic and functional outcomes. Clinical and radiographic follow-up demonstrated satisfactory functional rehabilitation. Patients were followed up for 6 months, during which no postoperative complications were observed. Conclusion: Preservation and adhesive stabilisation of residual coronal fragments may represent a tooth-preserving and clinically feasible treatment option for managing complex traumatic crown fractures when conventional fragment reattachment is impractical. This approach may facilitate definitive rehabilitation while minimising further loss of tooth structure.