We offer a case of a complicated crown and root fracture, in which intraalveolar transplantation was used using Ledermix paste mixed with calcium hydroxide as a provisional intraconduit medication, following its evolution for four years.
Description of the case:. In 1996 a thirteen year old boy came for consultation with a fracture of the upper right central incisor, of one week's evolution, without having received dental treatment. On examination, a complicated fracture of the crown-root was observed, reaching up to two millimetres below the marginal gingival margin. Surgical extrusion of the root was chosen. After anaesthesia with 4% Mepivacaine, an incision was made in the periodontal ligament and the root was luxated with an elevator, placed on the mesiopalatal and dystopalatal sides, respectively. The root was extracted and inspected for additional fractures. The apical fragment was repositioned, ensuring that the tooth was stabilised and the fracture was optimally exposed with minimal extrusion. The tooth was rotated to a position 90° from the original, which was considered the most stable, and then splinted to the adjacent teeth. To avoid interference during occlusion, part of the crown was removed.

One week after the initial treatment, the pulp was removed and filled with equal parts Ledermix and calcium hydroxide, and the crown was provisionally restored with composite. After six months, in the absence of signs of root resorption, the canal was definitively filled with gutta-percha, but the crown had discoloured, acquiring an intense grey colour. The non-vital teeth were bleached using a mixture of carbamide peroxide and glycerine (Endoperox®, Septodont France). The patient has been monitored for four years, with no signs of root resorption evident over this period of time.