Crown-Root Fracture (Complicated): Findings, Treatment & Trauma Assessment Example

Clinical Note: Dental Trauma Assessment Crown-Root Fracture (Complicated) Example

Chief Complaint: ______________________________

History of Trauma

• Date and Time: ______________________________
• Location of Injury: ___________________________
• Mechanism of Injury: (e.g., fall, sports, accident): ____________________________
• Initial Care Provided: ________________________

Medical History

• Allergies: _________________________________
• Medications: ______________________________
• Tetanus Status: ___________________________
• Relevant Medical History: ______________________

Dental History

• Previous Dental Injuries: ___________________________

Intraoral Findings

Soft Tissues:

• Lacerations: Minor lacerations noted on the labial gingiva adjacent to tooth #8.
• Bleeding: Localized gingival bleeding near the fracture site.
• Swelling: Mild swelling noted around the affected area.

Tooth Findings:

• Tooth #8:
  • Fracture: Crown-root fracture involving enamel, dentin, cementum, and pulp exposure.
  • Mobility: Coronal fragment showed moderate mobility.
  • Displacement: No significant displacement of the coronal fragment.
  • Percussion: Tender to percussion.
  • Sensitivity Testing (cold, electric pulp test): Negative response.

Radiograph

• Periapical and CBCT Imaging:
  • Fracture line extending obliquely from the crown into the coronal portion of the root, involving the pulp chamber.
  • No evidence of apical or root fractures beyond the coronal segment.
  • Periodontal ligament space appeared intact apically.

Plan

Immediate Management:

1. Fragment Management:
   • The mobile coronal fragment was carefully removed to prevent further trauma.
2. Pulp Therapy:
   • Partial pulpotomy with calcium hydroxide or MTA was performed to preserve pulp vitality in an open apex.
   • For a closed apex, complete pulpectomy/root canal treatment was initiated to address pulp necrosis.
3. Temporary Restoration:
   • Covered the exposed dentin with a glass ionomer dressing to prevent bacterial contamination and reduce sensitivity.
4. Definitive Restoration Plan:
   • Planned for crown lengthening or orthodontic extrusion to expose sufficient tooth structure for a definitive restoration.
   • Definitive restoration (e.g., composite crown or porcelain crown) to be placed after sufficient healing and root therapy.
5. Oral Hygiene:
   • Advised meticulous oral hygiene with gentle brushing to avoid bacterial contamination.
   • Recommended chlorhexidine rinse (0.12%) twice daily for 1 week to aid healing.
6. Medications:
   • Recommended ibuprofen 400-600 mg every 6-8 hours as needed for pain management.
   • Antibiotics prescribed if signs of infection or significant soft tissue damage are present.

Follow-Up Schedule:

• 2 Weeks: Reassess soft tissue healing and evaluate pulp therapy progress.
• 4-6 Weeks: Plan for definitive restoration after root therapy and gingival healing.
• 3-6 Months: Radiographic and clinical monitoring for resorption or healing complications.
• 1 Year: Evaluate the stability of the definitive restoration and ensure periodontal health.

Warning About Risks Associated with Dental Trauma

Complicated crown-root fractures involving pulp carry risks such as pulp necrosis, root resorption, and periodontal complications. Regular follow-ups and prompt reporting of symptoms like pain, mobility, or discoloration are critical to ensure successful outcomes.

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