Root fractures: a case of dental non-intervention

Self-revascularization following horizontal root fracture with lateral luxation injury in a permanent maxillary central incisor

Repair or regeneration of the pulp, following trauma, is a part of the wound healing process. However, pulp necrosis or root resorption, whether partial or complete, might obstruct this process. Because of the neurovascular bundle at the apical foramen and the periodontal ligament, the pulp in this fragment generally remains normal when the apical fragment is not moved. We describe a mature upper left central incisor with a horizontal root fracture in the mid-third of the root and lateral luxation that healed on its own after undergoing a procedure called self-revascularization. The fracture was detected during a routine dental checkup on a tooth that was asymptomatic. Two tooth pieces with trabecular bone between them were discovered using periapical radiography and cone-beam computed tomography (CBCT). Therefore, the endodontic intervention was not needed. Regular follow-up after trauma is mandatory to evaluate any signs of pulp necrosis. CBCT can help assess healing and identify resorption.

Conservative Management of Displaced Horizontal Root Fracture in Vital Maxillary Premolar: a Case Report

Background/Aim: The management of horizontal root fracture is not straight forward. It depends upon the location of the fracture, mobility and vitality of fractured tooth segment. The goal of treatment is to restore the shape and function of affected tooth.

Case report: This following case report described the conservative management of horizontal root fracture which was also displaced but somehow maintained its vitality. The affected tooth was initially stabilized and followed up in the subsequent appointments for evaluation of vitality that turned out to be vital, thus, preventing any unnecessary intervention.

Conclusions: Horizontal root fractures in the vital teeth should be initially managed conservatively and every effort should be made to preserve the vitality of tooth.

The maintenance of pulp health 17 years after root fracture in a maxillary incisor illustrating the diagnostic benefits of cone bean computed tomography

AIM

To demonstrate the maintenance of pulp health in a tooth with a fractured root without any complications or endodontic treatment and the advantage of cone bean computed tomography (CBCT) compared with traditional radiographs in the diagnosis of root fractures.

SUMMARY

The horizontal fracture of a maxillary central incisor is described that was an incidental finding on a routine radiographic examination 17 years after trauma. The tooth was asymptomatic. Intra-oral radiography revealed a complicated multiple root fracture with separation of the root fragments, which was not confirmed by CBCT. This case report illustrates spontaneous healing of root fracture and the reparative potential in the area of root fracture including preservation of pulp health and also demonstrates that CBCT is a more reliable imaging technique than conventional radiographs regarding root fracture diagnosis.

KEY LEARNING POINTS

The dental pulp is characterized by the ability to heal spontaneously in cases of root fracture. CBCT has advantages in diagnosing root fractures over intra-oral radiographs. CBCT should be employed with caution due to its increased radiation dose compared with periapical radiography.

Conservative treatment of a cervical horizontal root fracture and a complicated crown fracture: a case report

Abstract This case report describes successful long-term conservative management of a cervical root fracture and a complicated crown fracture of the maxillary central incisors in a 12-year-old patient. A mineral trioxide aggregate partial pulpotomy was performed on the maxillary right central incisor, while the maxillary left central incisor was splinted to the neighbouring lateral incisor using an acid-etch technique. Both teeth remained asymptomatic throughout the 3.5 years of a review period, with the cervical root fracture having mostly healed with the formation of a calcified tissue between the fragments. Two different treatment methods were used for two different injuries that resulted in pulp preservation in both cases. This in turn has provided for normal root development to occur while also allowing for preservation of bone.

Spontaneously healed horizontal root fracture in maxillary first premolar: report of a case

Root fractures of the posterior teeth are rare and occur as a result of severe trauma. This study describes the horizontal root fracture of a maxillary first premolar. The fractured roots were discovered during a routine radiographic examination. The tooth was asymptomatic and responded positively to electric pulp testing. The patient reported accidental trauma, which occurred 14 years before. Our case is an example of spontaneously healed fractured roots. The interesting findings were that the healing was observed even in the presence of two roots, including preservation of the vitality of the pulp.

Repair of untreated horizontal root fracture: a case report

We report a clinical case of horizontal root fracture in the mandibular first premolar induced by a traffic accident. The fractured tooth spontaneously healed and diagnosed radiographically after 2 years. Fractured fragments were separated by a narrow radiolucent line and the edges were rounded, and healing of the tooth is likely to be related to interproximal connective tissue healing. Our case is an example of spontaneously healed fracture roots. An interesting finding is that the healing was observed even in the presence of two root canals, the vitality of the pulp was preserved and displacement of fragments were prevented.

Spontaneously healed root fracture: report of a case

Blows to the facial region can cause root fractures especially in anterior teeth. Fractures below the alveolar crest have a very high potential for healing and treatment consists of reduction and rigid splinting immediately after trauma. The aim of the treatment is to obtain reunion of the fragments. Although the fracture can heal spontaneously, the prognosis will not be as good as the correctly treated ones. The purpose of this paper is to report a case of spontaneously healed root fracture.

Healing of 208 intra-alveolar root fractures in patients aged 7-17 years

This retrospective study consisted of 208 root-fractured, 168 splinted and 40 not splinted incisors in young individuals (aged 7-17 years) treated in the period 1959-1973 at the Pedodontic Department, Eastman Institute, Stockholm. Clinical and radiographic analyses showed that 69 teeth (33%) had developed hard tissue (fusion) healing of fragments. Interposition of periodontal ligament (PDL) and bone between the fragments was found in 17 teeth (8%). Interposition of PDL alone was found in 74 teeth (36%). Finally, non-healing with pulp necrosis and inflammatory changes between fragments was seen in 48 teeth (23%). Various clinical factors were analyzed for their relationship to the healing outcome with respect to healing/no healing and type of healing (hard tissue versus interposition of bone and/or PDL). Immature root and positive pulp sensitivity at time of injury was found to be significantly related to both pulp healing and hard tissue repair of the fracture. The same applied to concussion or subluxation of the coronal fragment compared to luxation with displacement (extrusive or lateral luxation). This relation was also represented by the variable millimeter diastasis between fragments before and after repositioning. Repositioning appeared to enhance the likelihood of both pulp healing and hard tissue repair. A positive effect of splinting, splinting methods (cap splints or orthodontic bands with an arch wire) or splinting periods could not be demonstrated on either pulp healing or type of healing (hard tissue versus interposition of bone and/or PDL). In conclusion, the findings from this retrospective study have cast doubts on the efficacy of long-term splinting and the types of splint used for root fracture healing. It is suggested that the role of splinting and splinting methods be examined in further studies.

Prognosis of root-fractured permanent incisors

The prognosis of 56 root-fractured permanent incisors was evaluated clinically and radiographically for 2 to 31 years. Information about initial case histories, examination and treatment of root-fractured teeth were recorded retrospectively from patient cards. Most of the root fractures occurred in the 16-20 year age group (38%) followed by the 11-15 year age group (29%). Males were involved more often than females. Fifty-two percent of the patients visited the dental clinic within the first week, while 48% did so 1 month-31 years later after the injury. The leading cause of root fractured injuries was falls (46%) and mostly involved one tooth (71%). Maxillary central incisors were the most often affected teeth (95%). The most common type of root fracture was in the middle third of the root (57%) followed by apical part (34%). About 59% of untreated or splinted teeth maintained their vitality. Healing with connective tissue was observed in 19 teeth, with calcified tissue in 15 teeth and with osseous tissue in only one tooth. There was partial or complete obliteration of the pulp space in these healed cases (62.5%). The formation of pulpal hard tissue produced no additional clinical problems. Partial or total pulp necrosis were noted in 21 (37.5%) teeth. Endodontic treatment was successful in 12 cases. The remaining 9 teeth were extracted due to the loss of marginal alveolar bone and apical periodontitis.

Repair of untreated root fracture: a case report

A case is presented in which an untreated root fracture in a maxillary central incisor of an adult male was found radiographically 10 years after injury. The tooth was removed and the area of the root corresponding to the fracture line was examined by SEM while the remaining tooth was processed for decalcified sections. Calcification of the coronal pulp associated with extensive tissue atrophy and normal pulp tissue apically was observed. Two barriers composed of dentinal and cemental hard tissue were present apically in the coronal fragment and in the fracture line.