Case Report Reattachment of subgingivally fractured central incisor with an open apex Fracture of the crown and the root with pulp exposure in a permanent tooth is a relatively uncommon injury. Andreasen (1) found that such fractures constitute between 5% and 8% of all traumatic injures. When they do occur, they present both endodontic and restorative problems. After a complex injury a pulpotomy or apexification is needed as treatment for an open apex. Pulpectomy is the most preferred endodontic treatment where the pulp is affected and, furthermore, the pulp canal could be used by a dowel for better retention of the restoration (2). Tooth fractures occur more often amongst young patients with immature apex and cause further treatment complications. For extensive pulpal involvement, a pulpotomy has been reported to be successful in allowing completion of root formation. In cases with subgingival fractures, apexification followed by root canal therapy is necessary as coronal restoration is not possible. Over time, numerous techniques have been developed for the reconstruction of injured teeth: resin crowns, orthodontic bands, ceramic crowns and resin composite restoration with and without pins (3). The use of composites, which have already been widely used for the reconstruction of anterior teeth, has enabled development of a technique to reattach the fractured dental fragment. This tech- nique was introduced at the end of the 1970s (4, 5). It involved the application of an adhesive on the fractured surfaces, which had been suitably cham- fered and etched, and then the interposition of resin composite between the fragment and tooth. Re- attachment of the dental fragment has only become possible with the improvement of adhesive and restorative materials. The possibility of dentin hybridization allows successful performance of den- tinal treatments previously impossible by means of conventional techniques (6–9). Using the original tooth fragment to restore a fractured tooth, it is possible to achieve very good aesthetics with original tooth contours, texture and radiolucency and function (10–13). Several case reports show that even subgingival tooth fractures could be restored successfully (12–17). Reattach- ment of the original tooth fragment in subgingival fractures provides a better biological surface for periodontal attachment. The following case report describes a young patient with a subgingival tooth fracture of a permanent tooth with an open apex and the results of the treatment. Case report A 6-year-old girl fractured her maxillary left incisor with an open apex while diving into a swimming Dental Traumatology 2007; doi: 10.1111/j.1600-9657.2005.00408.x DENTAL TRAUMATOLOGY 184 Dental Traumatology 2007; 23: 184–189 Ó 2007 Blackwell Munksgaard Eden E, Yanar SC ¸ , So ¨nmez S ¸ . Reattachment of subgingivally fractured central incisor with an open apex. Abstract – A case report of a 6-year-old girl with a fractured maxillary left central incisor with an open apex is presented. The procedure used to repair the fracture included flap surgery with an intrasulcular incision and endodontic treatment. The patient was called for 3 months regular follow-up to check the root formation. At the end of 32 months just before the root was obturated by guttaperka, she fractured the same tooth. Flap surgery was repeated and the tooth was restored. The root canal was obturated with a root filling paste and guttaperka as the apex was closed. Examination 10 months after treatment revealed good periodontal health, aesthetics and normal function. Ece Eden 1 , Saniye C ¸ic ¸ek Yanar 1 , S ¸ ule So ¨nmez 2 1 Department of Pedodontics, 2 Department of Periodontolo- gy, School of Dentistry, Ege University, Izmir, Turkey Key words: fragment reattachment; resin composite restoration; tooth fracture; periodontal surgery Ece Eden, Department of Pedodontics, School of Dentistry, Ege University, 35100 Bornova-Izmir, Turkey Tel.: +90-232-3886431 Fax: +90-232-3880325 e-mail: eceeden@yahoo.com Accepted 5 July, 2005