Pediatrics World Conference 2026

Abstract

Objective: Complex crown-root fractures involving subgingival fracture lines at the alveolar crest level present a major challenge in the management of immature permanent incisors, particularly when root development is incomplete. Conventional treatments often involve invasive procedures that may compromise pulp vitality, periodontal health, and long-term tooth survival. This study aimed to evaluate the clinical and radiographic outcomes of a minimally invasive, comprehensive protocol combining palatal gingival flap release, partial pulpotomy, and in situ crown reattachment for such injuries in pediatric patients.

Methods: Five children aged 8–10 years with immature permanent maxillary incisors presenting with complex crown-root fractures were included. All cases had palatal fracture lines extending to the alveolar crest, pulp exposure at the fracture site, and incompletely developed, wide open apices. Under local anesthesia, a minimally invasive palatal gingival flap was elevated and released to expose the subgingival fracture margin. Partial pulpotomy was performed under an operating microscope, removing approximately 2 mm of coronal pulp tissue to eliminate contaminated pulp. Hemostasis was achieved with sterile saline irrigation, and the pulp wound was capped with a bioceramic material, followed by a protective liner. The fractured crown segments were cleaned, conditioned, and reattached in situ using dual-cure resin cement, and the final anatomy was restored with light-cured composite resin. Clinical and radiographic follow-up examinations were scheduled at 3, 6, and 12 months postoperatively to assess pulp vitality, periodontal status, marginal integrity, root development, and patient-reported esthetic and functional satisfaction.

Conclusion: The combined protocol of minimally invasive palatal gingival flap release, partial pulpotomy, and in situ crown reattachment is a predictable, tooth-preserving approach for managing complex crown-root fractures in immature permanent incisors with subgingival fracture lines. It effectively maintains pulp vitality to support continued root development, preserves natural tooth structure, and achieves favorable long-term esthetic and functional outcomes. This treatment strategy offers a valuable alternative to more invasive procedures in pediatric dental trauma management.