A Novel Treatment for Propagated Crown Fractures

Published:August 14, 2014DOI:



      A major complication after endodontic treatment is persistent pain on biting or chewing. Although unsuccessful endodontic treatment can account for such pain, pain to chewing and biting can also be a result of an unsupported or propagated crown fracture. Crown fractures that extend apically result in deterioration of the localized periodontium and ultimate loss of the tooth. To date, no predictable treatment for apically extending crown fractures exists.


      Three cases of nonsurgical excision of a propagated crown fracture and the repair of the subsequent iatrogenic perforation are presented.


      This case report series describes a novel treatment for apically progressive crown fractures that results in patient comfort and maintenance as well as improved periodontal status of the tooth.

      Key Words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Endodontics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Salehrabi R.
        • Rotstein I.
        Endodontic treatment outcomes in a large patient population in the USA: an epidemiological study.
        J Endod. 2004; 30: 846-850
        • Hansen E.K.
        • Asmussen E.
        • Christiansen N.C.
        In vivo fractures of endodontically treated posterior teeth restored with amalgam.
        Endod Dent Traumatol. 1990; 6: 49-55
        • Vire D.E.
        Failure of endodontically treated teeth: classification and evaluation.
        J Endod. 1991; 17: 338-342
        • Zadik Y.
        • Sandler V.
        • Bechor R.
        • Salehrabi R.
        Analysis of factors related to extraction of endodontically treated teeth.
        Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2008; 106: e31-e35
        • Santos-Filho P.C.
        • Verissimo C.
        • Soares P.V.
        • et al.
        Influence of ferrule, post system, and length on biomechanical behavior of endodontically treated anterior teeth.
        J Endod. 2014; 40: 119-123
        • Krell K.V.
        • Rivera E.M.
        A six year evaluation of cracked teeth diagnosed with reversible pulpitis: treatment and prognosis.
        J Endod. 2007; 33: 1405-1407
        • Kim S.Y.
        • Kim S.H.
        • Cho S.B.
        • et al.
        Different treatment protocols for different pulpal and periapical diagnoses of 72 cracked teeth.
        J Endod. 2013; 39: 449-452
        • Floratos S.G.
        • Kratchman S.I.
        Surgical management of vertical root fractures for posterior teeth: report of four cases.
        J Endod. 2012; 38: 550-555
        • Tang W.
        • Wu Y.
        • Smales R.J.
        Identifying and reducing risks for potential fractures in endodontically treated teeth.
        J Endod. 2010; 36: 609-617
        • Bader J.D.
        • Shugars D.A.
        • Sturdevant J.R.
        Consequences of posterior cusp fracture.
        Gen Dent. 2004; 52: 128-131
        • Burklein S.
        • Tsotsis P.
        • Schafer E.
        Incidence of dentinal defects after root canal preparation: reciprocating versus rotary instrumentation.
        J Endod. 2013; 39: 501-504
        • Main C.
        • Mirzayan N.
        • Shabahang S.
        • Torabinejad M.
        Repair of root perforations using mineral trioxide aggregate: a long-term study.
        J Endod. 2004; 30: 80-83
        • Mente J.
        • Hage N.
        • Pfefferle T.
        • et al.
        Treatment outcome of mineral trioxide aggregate: repair of root perforations.
        J Endod. 2010; 36: 208-213
        • Pace R.
        • Giuliani V.
        • Pagavino G.
        Mineral trioxide aggregate as repair material for furcal perforation: case series.
        J Endod. 2008; 34: 1130-1133
        • Holland R.
        • Filho J.A.
        • de Souza V.
        • et al.
        Mineral trioxide aggregate repair of lateral root perforations.
        J Endod. 2001; 27: 281-284
        • Torabinejad M.
        • Pitt Ford T.R.
        • McKendry D.J.
        • et al.
        Histologic assessment of mineral trioxide aggregate as a root-end filling in monkeys.
        J Endod. 1997; 23: 225-228
        • Seghi R.R.
        • Nasrin S.
        • Draney J.
        • Katsube N.
        Root fortification.
        J Endod. 2013; 39: S57-S62
        • May J.J.
        • Cohenca N.
        • Peters O.A.
        Contemporary management of horizontal root fractures to the permanent dentition: diagnosis–radiologic assessment to include cone-beam computed tomography.
        J Endod. 2013; 39: S20-S25
        • Seo D.G.
        • Yi Y.A.
        • Shin S.J.
        • Park J.W.
        Analysis of factors associated with cracked teeth.
        J Endod. 2012; 38: 288-292