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case_images: Extraoral picture of the patient at the time of arrival.
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case_images: fig1
case_images: A 10-year-old boy presented to the endodontic department at the Faculty of Dentistry, King Abdul Aziz University, roughly 3 hours after sustaining a traumatic injury to his maxillary anterior teeth and upper lip (Figure 1). Multiple tooth fragments were found to be loosely attached to the gingiva and both maxillary central incisors incurred complicated crown-root fractures during the injury (Figure 1).
case_images: (a) Maxillary occlusal radiograph showing irregular fracture lines of maxillary teeth. (b) Mandibular occlusal radiograph showing normal dentition.
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case_images: fig2
case_images: The teeth showed full root length formation with half-open apices (Figure 2).
case_images: Sagittal CBCT views of (a) #11 and (b) #21 showing multiple fracture lines and loose fragments. From the image scale, the fracture lines extend subcrestally 2 mm in #11 and 5 mm in #21. The dotted lines represent CEJ and bone crest (BC). Therefore, the level of intrusion is approximately 3 mm in #11 and 6 mm in # 21. Root development shows immature apical formation (open apex) in both teeth.
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case_images: fig3
case_images: The sagittal views showed oblique fracture lines extending toward the subcrestal palatal bone approximately 2 mm into tooth #11 and 5 mm into tooth #21 (Figure 3).
case_images: Axial CBCT views showing the position of crowns (a) and roots (b) of #11 in relation to #21 indicating labial intrusion of #21.
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case_images: fig4
case_images: The axial views show the labial intrusion of tooth #11 as the position of the crowns and roots of maxillary teeth are compared to each other (Figure 4).
case_images: Periapical radiographs of teeth #11 and #21 showing (a) calcium hydroxide paste. (b) Root canal treatment completed. (c) Fiber post and composite core restorations.
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case_images: The pulp of the teeth was extirpated, and the canals were irrigated with a chlorhexidine solution followed by an intracanal nonsetting calcium hydroxide paste (Apexit, Ivocalrvivadent, Liechtenstein, Germany) (Figure 5(a)). Apical plugs were created using bioceramic putty (EndoSequence, Brasselers, USA), and the canals were filled with thermoplasticized gutta-percha followed by sealing the access with glass ionomer restoration (Figure 5(b)). In the subsequent visit, the teeth were restored with fiber posts and composite cores (Figure 5(c)) to prevent gingival overgrowth and restore the esthetic appearance of the child while waiting for spontaneous eruption.
case_images: Clinical picture showing eruption of #11 and labial eruption of tooth #21 through the gingiva.
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case_images: fig6
case_images: In the following visit (4 weeks), tooth #11 had shown obvious signs of reeruption with 1-2 mm of sound tooth structure can be seen coronal to the gingival margin (Figure 6).
case_images: Clinical picture showing tooth #21 after gingivectomy.
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case_images: fig7
case_images: A gingivectomy of the labial tissue was then performed with electrosurgery (PerFect TCS, Coltene, Cuyahoga Falls, OH, USA) to expose the sound tooth structure (Figure 7).
case_images: Frontal and occlusal clinical pictures of the teeth after bonding the orthodontic appliance.
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case_images: fig8
case_images: Brackets sized 0.022 slot (OC orthodontics, McMinnville, OR, USA) were passively bonded on the permanent maxillary incisors, and a stainless steel wire size 0.019 x 0.025 was inserted (Figure 8).
case_images: Periapical radiographs showing (a) midway through active orthodontic eruption and (b) after 2-month stabilization before removing the brackets. Tooth #21 shows good crown-to-root ratio after full extrusion. (c) Clinical picture showing the position of teeth after removal of the brackets.
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case_images: fig9
case_images: The total time for extrusion was two months, at which point 1-2 mm of supragingival sound tooth structure was gained (Figure 9).
case_images: (a) Clinical picture and (b) PA radiograph showing tooth #21 after post and core buildup.
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case_images: fig10
case_images: After restoring tooth #21 with a new fiber post and composite core (Figure 10), the patient was scheduled to have the teeth restored with temporary crowns on the next visit.
case_images: (a) Clinical picture and (b) PA radiograph showing teeth #11 and #21 after temporary crown cementation.
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case_images: fig11
case_images: Teeth #11 and #21 were restored with temporary crowns (Protemp  Plus, 3M, US), and both the patient and his parents were satisfied (Figure 11).
case_images: (a) Periapical and (b) CBCT radiographs showing periapical lesion related to tooth #11 and apical closure of tooth #21.
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case_images: fig12
case_images: A limited field CBCT confirmed the findings of a periapical lesion about 6 x 3 mm in size related to tooth #11 (Figure 12).
case_images: Clinical pictures showing before and after cementation of final ceramic crowns.
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case_images: fig13
case_images: The final restorative treatment was completed and included ceramics crowns (IPS e.max Press, Ivocalrvivadent, Liechtenstein, Germany) in shade A3 which were cemented with resin cement (Multilink Automix, Ivocalrvivadent, Liechtenstein, Germany) (Figure 13).
case_images: One-week postsurgery follow-up. (a) Clinical image showing healing of the surgery site. Mild gingival inflammation can be seen distal to tooth #21. PA radiographs of (b) before and (c) after surgery.
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case_images: fig14
case_images: The one-week postsurgery visit showed healing of the surgical site (Figure 14).
case_images: Six-month postsurgery follow-up. (a) Clinical picture showing healthy gingiva and good esthetics. (b, c) PA radiographs showing healing of the surgical site and proper adaptation and proximal contour of the new crowns.
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case_images: fig15
case_images: At six months postsurgery follow-up, progressive healing of the lesion and better gingival health were evident (Figure 15).