Anterior teeth fracture is a common form of dental trauma that mainly affects children and adolescents,¹,² and maxillary central incisors are the most commonly affected teeth.³ Loss of coronal tooth structure might affect esthetics and function.¹

In recent decades, dentistry has shown many scientific and technological advances in restorative materials.⁴ However, no synthetic restorative material can replicate the natural tooth structure. Hence, the use of natural tooth as a restorative material has been suggested in literature and is termed as biological restoration.⁵

The following case report represents a clinical case performed by means of a biological post and crown by reattachment of fractured crown using biological post with 1-year follow-up.

A 21-year-old male patient was referred to the department of conservative and endodontics after sustaining a complicated crown fracture on his permanent maxillary left central incisor in a road traffic accident, while riding a bike.

Clinical and radiographic examination

Clinical examination revealed complicated Ellis class III fracture of maxillary left central incisor with retained fractured segment and Ellis class II of maxillary right central incisor and lateral incisor Figure 1a. Maxillary right central and lateral incisor showed no tenderness on percussion and no mobility. Intraoral periapical radiograph (IOPAR) was advised with respect to maxillary incisors. IOPA revealed an oblique crown fracture in tooth 21 Figure 2a.Figure 1

(a) Preoperative, (b) after removal of fractured fragment.

Sometimes, remaining tooth structure requires additional intraradicular retention;³ to achieve this, various post systems can be used, such as custom-made post or prefabricated post made of fiber glass, carbon fiber, metal, or ceramics. However, no commercially available posts fulfill all the mechanical and biological requirements. The only material that can have all these properties is none other than the dentin itself.⁸ Hence, the use of biological dentin post and biological crowns have been suggested in the literature.¹,²,⁹,¹⁰

In the present case, since the coronal destruction extended to the cervical third of tooth, the use of intraradicular retention was deemed necessary. This retention was achieved with biological posts,¹¹ and esthetics was maintained by reattaching patient's own crown fragment.

Although the tooth fragment reattachment is usually done with more predictable results in simple cases with clinically visible fracture line, this case report with a 1-year follow-up demonstrated that this procedure can be performed even in complex crown fractures where the biologic width is violated, corroborating Peixoto et al.,¹² Durkan et al.,¹³ and Rajput et al.¹⁴ However, periodontal health is an important determinant in the success of these cases. Peixoto et al. presented a case with an oblique crown fracture in the maxillary right lateral incisor, extending from the buccal to palatal side, as well as biological width invasion. Hence, the reestablishment of biological width was obtained by periodontal surgery to achieve clinical crown lengthening and tooth fragment reattachment with a glass fiber post to increase retention. After 3 years of follow-up, the rehabilitated lateral incisor remained in good condition, with satisfactory esthetic and periodontal health.¹² However, long-term follow-up visits should be planned for clinical and radiographic confirmation of good esthetics, function, and periodontal health. Hence, the success rate of the technique is case dependent. Furthermore, advanced imaging techniques like cone-beam computed tomography could be considered for further evaluation of the treatment outcome.

Corrêa-Faria et al. published a case report of successful use of biological dentin posts and biological crowns to recover the esthetics and functions of extensively damaged maxillary central incisors with 1-year follow-up.¹ Vaz et al. reported a case of fractured maxillary central incisors restored with the use of biological post followed by direct composite restoration of maxillary right central incisor, while maxillary left central incisor was restored with prefabricated fiberglass followed by direct composite restoration.⁴

Biological dentin post has several advantages as it exhibits similar mechanical properties and esthetics as that of dentin.¹¹,¹⁵ This is a low-cost procedure and could be accepted as a useful technique for cost-conscious patients with good oral hygiene and satisfactory periodontal health.¹¹ However, it has some limitations such as patient acceptance, difficult retrieval, availability of teeth with similar structure, and similar tooth color.¹⁶ Furthermore, adaptation of the post to the root canal may be less accurate. Hence, CAD-CAM may be used in future research to achieve the accurate dimensions of biological posts as that of post space.

The present case study represents the successful use of biological post and crown and was adequate with respect to adhesion, function, and esthetics with the follow-up period of 1 year. Hence, it may be concluded that the biological restorations, if feasible, is a cost-effective way to restore a damaged tooth with acceptable esthetics and tooth functions in the stomatognathic system.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

The authors of this manuscript declare that they have no conflicts of interest, real or perceived, financial or nonfinancial in this article.