Mx of lateral incisor fractured at crestal level: An interdi
This article, published in the Indian Journal of Dental Sciences reports a case with 2½ years of clinical and radiographic follow-up success of maxillary left lateral incisor with crown-root fracture using orthodontic extrusion and fibrotomy.

A 19-year-old male patient reported 20 min after blow injury to the maxillary anterior region with a chief complaint of fractured tooth. Clinical and radiographic examination revealed fractured maxillary left lateral incisor below gingival margin. At that time, even maxillary left central incisor did not respond to vitality test. The patient desired the tooth replacement but not at the expense of extraction.

Remaining root length was calculated on radiograph and found to be 13 mm, with coronal level adjacent to the crestel bone. After consideration of crown-to-root ratio, it was decided to extrude 4 mm of root orthodontically to maintain crown-to-root ratio 1:1 and to preserve the biological width. RCT of lateral incisor was started at the first appointment.

On the next appointment, maxillary central incisor was severely tender. Hence, RCT of central incisor was also started. Ca (OH)2 (prime dental) dressing was given for 7 days. RCT was completed after 10 days, and postspace was prepared. After the patient was free from all symptoms, the case was discussed with the Department of Orthodontics for orthodontic extrusion.

It was decided to bond brackets on maxillary left canine and both central incisors to act as anchoring teeth. Prepared postspace was checked for insertion of 21G wire with an eyelet. Wire was cemented with zinc phosphate cement (Harvard cement) keeping the eyelet outside the root portion available for the insertion of elastic band.

Then, 0.0175” multistranded wire was adapted to the brackets on the anchoring teeth passing over left lateral incisor. An elastic band was engaged between eyelet and orthowire. First supracrestal fibrotomy was done on the day of activation of elastic band.

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