Outcomes of Intentional Replantation in the Management of Crown-Root Fracture of the Maxillary Right Central Incisor

This study aimed to demonstrate the potential of intentional replantation in treating a crown-root fracture of tooth 8 (ISO designation 11) that occurred 6 months earlier in a 12-year-old male. A crack in the coronal portion of the tooth extended from the center of the incisal edge apically beyond the cervical margin. Intraoral radiography and cone-beam computed tomography revealed a vertical fracture line extending 3 mm apical to the alveolar crest and bone loss in the apical region and around the mid-root area. During surgery, the root was atraumatically extracted. Its length (12 mm) and an extra-alveolar time of <1 minute enabled tooth preservation—intentional replantation of the root into the socket. The tooth was stabilized using a wire-composite splint for root canal therapy. The root canal was mechanically and chemically prepared and temporarily filled with calcium hydroxide. Gingival margin approximation was performed using sutures. Splinting was maintained for 3 weeks. The patient received anti-inflammatory therapy, antibiotics, and antiseptic mouthwashes. Sutures were removed 3 weeks postoperatively. The root canal was re-instrumented and obturated. Tooth 8 was restored with a glass fiber post and composite resin. After tooth preparation, a CAD/CAM composite crown was fabricated and adhesively cemented. At 11-month follow-up, nearly complete bone defect healing was observed. Intentional replantation was highly effective in crown-root fracture management, enabling tooth preservation despite an unfavorable prognosis.