Orthodontic movement of a horizontal root fractured tooth

Horizontally root fractured teeth with pulpal vitality - two case reports

This case study reports the successful outcome of horizontal root fractures of two different patients, which took place in permanent incisors. Report 1 describes a case of a 29-year-old patient who suffered a mandibular trauma affecting mainly the lower central incisors, caused by a car accident. A panoramic radiograph was taken right after the accident and showed a horizontal root fracture in the middle third of tooth 42, which went untreated. Report 2 illustrates a case of a 17-year-old male patient who searched for orthodontic therapy and the periapical radiograph showed horizontal root fracture in tooth 11 caused by a previous trauma, which went untreated as well. There was healing through the reestablishment of pulp activity and dental coloration without professional intervention.

Orthodontic movement of two root fractured teeth: a case report

AIM

To illustrate significant tipping orthodontic movement of root fractured teeth.

SUMMARY

As the frequency of root fractured maxillary teeth is related to increased overjet and reduced lip coverage, orthodontic treatment may increase lip coverage and reduce the risk of trauma or its severity. It may also be necessary to move previously traumatized teeth. Two root fractured teeth were tipped through a considerable angle (19 degrees ) to reduce a large overjet and followed up for 5 years.

KEY LEARNING POINTS

-- Reduction of large overjets involving root fractured teeth may not affect pulp vitality. -- Root fragment separation prior to orthodontics did not appear to increase in this patient, but angulation of the fragments did not completely follow the major change to the coronal part of the tooth.

Orthodontic movement of a horizontally fractured tooth: a case report

Intra-alveolar root fractures are relatively uncommon, and sometimes may be healed without treatment. Diagnosis of intra-alveolar root fracture is frequently made by exclusion of clinical signs of other traumatic injury, and by radiographic examination with films taken at different tube angulations. This case report presents a horizontal root fractured tooth that was healed satisfactory without treatment and moved orthodontically after prolonged time from trauma.

Management of a horizontal root fracture after previous root canal therapy

This case report concerns a 9-year-old girl who had a horizontal root fracture of her maxillary left central incisor and had root canal therapy performed by her family dentist immediately after the injury. Because of the incomplete canal obturation, the root canal filling material was removed, and calcium hydroxide therapy was initiated. Healing at the fracture site occurred, with hard tissue forming between the root segments. The coronal segment of the root was then obturated with gutta-percha. The patient later had orthodontic treatment with some movement of the coronal segment. Six-year post-treatment follow-up shows apparent clinical and radiographic success. This case illustrates the potential for repair of a horizontal root fracture after endodontic retreatment of the coronal segment and long-term splinting.

Endodontic-orthodontic relationships: a review of integrated treatment planning challenges

Literature review There is a paucity of information on the concise relationship between endodontics and orthodontics during treatment planning decisions. This relationship ranges from effects on the pulp from orthodontic treatment and the potential for resorption during tooth movement, to the clinical management of teeth requiring integrated endodontic and orthodontic treatment. This paper reviews the literature based on the definition of endodontics and the scope of endodontic practice as they relate to common orthodontic-endodontic treatment planning challenges. Literature data bases were accessed with a focus on orthodontic tooth movement and its impact on the viability of the dental pulp; its impact on root resorption in teeth with vital pulps and teeth with previous root canal treatment; the ability to move orthodontically teeth that were endodontically treated versus nonendodontically treated; the role of previous tooth trauma; the ability to move teeth orthodontically that have been subjected to endodontic surgery; the role of orthodontic treatment in the provision for and prognosis of endodontic treatment; and, the integrated role of orthodontics and endodontics in treatment planning tooth retention. Orthodontic tooth movement can cause degenerative and/or inflammatory responses in the dental pulp of teeth with completed apical formation. The impact of the tooth movement on the pulp is focused primarily on the neurovascular system, in which the release of specific neurotransmitters (neuropeptides) can influence both blood flow and cellular metabolism. The responses induced in these pulps may impact on the initiation and perpetuation of apical root remodelling or resorption during tooth movement. The incidence and severity of these changes may be influenced by previous or ongoing insults to the dental pulp, such as trauma or caries. Pulps in teeth with incomplete apical foramen, whilst not immune to adverse sequelae during tooth movement, have a reduced risk for these responses. Teeth with previous root canal treatment exhibit less propensity for apical root resorption during orthodontic tooth movement. Minimal resorptive/remodelling changes occur apically in teeth that are being moved orthodontically and that are well cleaned, shaped, and three-dimensionally obturated. This outcome would depend on the absence of coronal leakage or other avenues for bacterial ingress. A traumatized tooth can be moved orthodontically with minimal risk of resorption, provided the pulp has not been severely compromised (infected or necrotic). If there is evidence of pulpal demise, appropriate endodontic management is necessary prior to orthodontic treatment. If a previously traumatized tooth exhibits resorption, there is a greater chance that orthodontic tooth movement will enhance the resorptive process. If a tooth has been severely traumatized (intrusive luxation/avulsion) there may be a greater incidence of resorption with tooth movement. This can occur with or without previous endodontic treatment. Very little is known about the ability to move successfully teeth that have undergone periradicular surgical procedures. Likewise, little is known about the potential risks or sequelae involved in moving teeth that have had previous surgical intervention. Especially absent is the long-term prognosis of this type of treatment. During orthodontic tooth movement, the provision of endodontic treatment may be influenced by a number of factors, including but not limited to radiographic interpretation, accuracy of pulp testing, patient signs and symptoms, tooth isolation, access to the root canal, working length determination, and apical position of the canal obturation. Adjunctive orthodontic root extrusion and root separation are essential clinical procedures that will enhance the integrated treatment planning process of tooth retention in endodontic-orthodontic related cases.

Extrusion of root-filled incisors in beagles--a light microscope and scanning electron microscope investigation

The response of the periodontal ligament to orthodontic extrusion of the incisor of a beagle was examined with light microscope and scanning electron microscope techniques. The ligament morphology was slightly altered by the procedure but was essentially normal. Teeth that were extruded and retained for 12 weeks exhibited partial relapse. Where a full thickness mucogingival flap was raised and immediately replaced in lieu of retention, continued extrusion was observed. Root resorption was observed at the interproximal region of the cervical third in three out of five specimens. The resorption had been repaired with cellular cementum.