PRACTICE • After a subgingival crown-root fracture, if the remaining portion of the root is thought to be enough to support a definitive restoration, the root may be extruded. • Extraction may not be the first treatment choice for fractured and extremely broken down, young, permanent teeth in the anterior region. • Patient cooperation must be well established for the treatment of such trauma cases. IN BRIEF A conservative multidisciplinary approach for improved aesthetic results with traumatised anterior teeth N. Arhun, 1 A. Arman, 2 M. Ungor 3 and S. Erkut 4 A subgingival crown-root fracture presents a restorative problem to the clinician because restoration is complicated by the need to maintain the health of the periodontal tissues. If the remaining portion of the root is thought to be enough to support a definitive restoration, the root may be extruded by orthodontic forced eruption after root canal treatment. Extru- sion enables the remaining root portion to be elevated above the epithelial attachment. Endodontic posts may be useful in exerting vertical forces to the root for extrusion without buccal tipping. The following case shows multidisciplinary man- agement of a case of dental trauma. Orthodontic forced eruption is incorporated using endodontic posts and restoration with porcelain fused to metal crowns — leading to successful restoration of the traumatised teeth. INTRODUCTION Horizontal root fractures most often occur in maxillary central incisors due to trauma. 1 Root fractures are also more likely to take place in fully erupted permanent teeth with closed apices in which the completely formed root is solidly supported by bone and the periodontium. 2 If the fracture line is positioned below the alveolar bone mar- gin, and if the apical root fragment is judged to be long enough to support a coronal restoration, the coronal frag- ment can be removed and the root treated endodontically. 3 For favourable prosthodontic coro- nal restoration of the remaining root, orthodontic extrusion of the root may be helpful. Subsequently, the root can be reconstructed with a coronal restora- tion. The prime objective of orthodon- tic extrusion is to provide both a sound tissue margin for ultimate restoration and to create a periodontal environ- ment (biologic width) that will be easy to maintain. 4 Orthodontic extrusion can be achieved with various kinds of fi xed or removable orthodontic appliances. 5,6 When using a conventional fi xed appliance, elas- tic traction may induce a more buccal force component during the extrusion, as brackets and wires of the anchoring teeth are positioned more buccally than the root. This results in buccal tipping or rotation during extrusion, and a direct consequence of this is that compensa- tory and time-consuming bending of the wires must be performed to avoid buccal displacement of the root. 7 A self-sup- porting spring or elastic module, apply- ing vertical extrusive force to the tooth through a small bonded attachment, is also a common method. 5,9,10 After adequate extrusion is achieved by forced eruption, a fibreotomy of the stretched periodontal fibres is usually performed to avoid relapse after extru- sion. This allows the fibres to heal and reorganise in the new position of the root. 5,8 In some cases it also may be necessary to overextrude the root. 8 The most evident advantage of this tech- nique is the permanence and biological compatibility of the finished result. The gingival papillae will properly surround all the teeth. The incidence of healing of horizon- tal root fractures is reported to be 80%. 1 Furthermore, teeth with root fractures have a better chance of maintaining their vitality than luxated teeth with- out fractures. 11 These root fractures may heal with calcified tissue, connective 1* Assistant Professor, Baskent University, Faculty of Dentistry, Department of Conservative Dentistry, An- kara, Turkey; 2 Assistant Professor, Baskent University, Faculty of Dentistry, Department of Orthodontics, An- kara, Turkey; 3 Associate Professor, Baskent University, Faculty of Dentistry, Department of Endodontics, An- kara, Turkey; 4 Assistant Professor, Baskent University, Faculty of Dentistry, Department of Prosthodontics, Ankara, Turkey *Correspondence to: Dr Neslihan Arhun Email: neslihan@baskent.edu.tr Refereed Paper Accepted 8 March 2006 DOI: 10.1038/sj.bdj.4814158 © British Dental Journal 2006; 201: 509-512 BRITISH DENTAL JOURNAL VOLUME 201 NO. 8 OCT 21 2006 509