Multidisciplinary Approach toward the Management of Oblique Fracture in the Maxillary Central Incisor: A Case Report with 1-year Follow-up

Abstract

This case report describes the successful management of an oblique fracture of #11 with a fracture line that extended subgingivally by following a multidisciplinary protocol to preserve biological width and improve long-term prognosis. A 28-year-old male patient presented with a fractured front tooth caused by a fall. After a brief period of pain following the trauma, the patient was asymptomatic. An oblique fracture (Ellis Class III) in the coronal third of the upper right central incisor (#11 in the FDI teeth numbering system) with exposed pulp tissue was discovered during the routine clinical examination. When the fractured fragment was removed under local anesthesia, the fracture line was found to be extending subgingivally along the palatal aspect of the tooth. A multidisciplinary approach involving endodontic therapy and periodontal management involving flap reflection was adopted to attain a favorable long-term prognosis. The therapy comprised root canal treatment, crown lengthening, mucoperiosteal flap reflection, osseous re-contouring, composite core build-up, and final restoration using a porcelain fused to metal crown. This multidisciplinary approach, at 1-year follow-up, showed uneventful healing, and was able to achieve excellent esthetics and function while also preserving the patient’s natural tooth.