For managing crown root fracture with little or no violation of the biologic width
when coronal fragment is available one of the best options is reattachment of the fractured fragment.
The dimension of dentogingival complex, called "biologic width
," is present around the natural teeth in the form of a protective cuff-like barrier.
(ii) Removal of the coronal fragment and supplement with gingivectomy or/and osteotomy to expose the fracture line in order to establish biologic width
prior to restoration.
Crown lengthening involves the surgical removal of hard and soft periodontal tissues to gain supracrestal tooth length, allowing for clinical crowns and reestab- lishment of the biological width.12 Crown lengthening has been described as a procedure similar to an apically repositioned flap with ostectomy/osteoplasty.13 The lengthening procedure is indicated to provide tooth length for caries removal, restoration of the tooth with- out violating the biologic width
, restoration retention and aesthetics.14
Its features provide excellent me- chanical strength, and allow the preservation of the peri-implant biologic width
integrity for optimal aesthetic result.
[12, 13] investigated whether biologic width
was influenced by apicocoronal position of implants (crestal, 1 and 2 mm apical to the crest) submitting them to immediate or conventional loading.
: Evaluation and Correction of its Violation.
Chapters cover the harmony of face, lips and teeth, the dentogingival complex, axial crown contours, pontic to edentulous ridge relationships, biologic width
around implants, esthetic integration, healthy teeth, restorative materials, clinical cases, and intact teeth.
Several factors influence the management of coronal tooth fractures, including extent of fracture (biologic width
violation, endodontic involvement, alveolar bone fracture and restorability of fractured tooth) secondary trauma injuries (soft tissue status), presence/absence of fractured tooth fragment and its condition for use (fit between fragment and the remaining tooth structure),occlusion, aesthetics, finances and prognosis.
When exposing the fracture margin, it was observed that the fracture line was located intraosseously, invading the biologic width
. Therefore, osteotomy and osteoplasty were necessary in the palatal region, removing approximately 1 mm of bone tissue.
Complicated crown-root fractures on the other hand presents challenge to the restorative dentist for its management because of encroachment of biologic width
and its subgingival nature.