Repair characteristics of horizontal root fracture: a case report

Healing After Horizontal Root Fracture of Maxillary Central Incisor: A Case Report With 24-Month Follow-Up

Facial traumatic injuries are quite common, resulting in the fracture and displacement of tooth and/or bone fragments. Loss of tooth structure may have lifetime consequences for the patient. Horizontal root fractures (HRFs) may occur in the maxillary anterior teeth at different locations, showing varied patterns of healing. The treatment options range from simple observation and follow-ups to conservative management or even complex surgical procedures. Correct and timely intervention can help preserve the tooth structure, leading to the long-term survival of the tooth. The present case report showcases endodontic treatment and favourable healing of a horizontal root fracture at the apical third of a permanent maxillary central incisor. At the 24-month follow-up, the tooth is clinically healthy, and radiographic images show a successful outcome.

Conservative management of a horizontal root fracture in a primary maxillary central incisor: Case report

Dental trauma occurs frequently in toddlers and the treatment protocols vary depending on each case. Thus, clinicians must not only plan the treatment but also consider any possible sequelae and characteristics related to the child and the family. The aim of this paper was to report a case of a three-year-old boy who had a horizontal root fracture in the middle third of the primary maxillary right incisor root (tooth 51) and crown discoloration of the primary maxillary left incisor (tooth 61) which were successfully treated with conservative management. The management was established in agreement with the family and was based on active surveillance. The clinical and radiographic follow-ups showed no changes besides pulp canal calcification of the left incisor throughout the eight years of follow-up. The pulps remained normal with no pathological signs throughout their life cycle and the permanent successors erupted normally, presenting an excellent result of the non-invasive approach adopted.

Combined Management of Apical Root Fracture and Avulsion of Two Maxillary Permanent Central Incisors: A Case Report

As a result of a skiing accident, a ten-year-old girl suffered combined injuries to both maxillary central incisor teeth (#1.1 and #2.1). The injuries were uncomplicated crown fractures, apical horizontal root fractures, and a severe extrusive luxation of the coronal segments of the teeth. Her mother repositioned the teeth immediately, resulting in good initial healing. Nine months later, the patient was referred to a specialist to manage the endodontic consequences of the trauma. The apexification treatment of the fractured roots, using a preformed apical barrier technique with bioactive cement, was the treatment of choice, administered to both the avulsed roots at two separate recall visits. The best option for managing the fractured apical segments was to continue with the follow-up, which was conducted to assess the overall case at 30 months. The fractured apexes remained normally positioned inside the socket and were asymptomatic (as they presumably maintained a physiological vascular-nerve supply and, consequently, their vitality), while the apexification treatment led to the healing of the periodontal tissues and to hard tissue formation in the area of the interrupted roots in the avulsed portion of the teeth. The management of traumatic injuries in teeth often requires multiple treatment approaches, because these injuries rarely represent one single type of trauma.

Combined orthodontic, surgical, and restorative approach to treat a complicated crown-root fracture in a maxillary central incisor

This case report shows the treatment of a severe traumatic tooth injury. For the maxillary right central incisor, the trauma was considered a complicated crown-root fracture. The level of the fracture line, the length of the remaining root segment, and the presence and condition of the tooth fragment determined the type of therapy. Traumatized teeth with fractures below the alveolar crest are often considered hopeless. As this report shows, the treatment of a complicated crown-root fracture in the esthetic region can be challenging. Orthodontic extrusion and crown-length surgery were performed to bring the fracture line above the alveolar bone crest. A multidisciplinary approach was required for complete rehabilitation of the traumatized maxillary incisor. Suggestions are made to improve treatment planning of complicated crown-root fractures.

Conservative Management of Horizontal Root Fracture - A Case Series

Root fracture has been defined as a fracture involving dentin, cementum, pulp and periodontal ligament. Depending on the level of the fracture line various treatment modalities may be employed by the clinician to promote healing. The following case reports highlight how changes in technique allow for conservative management of horizontal root fractures at different levels. This approach allows the patient to retain their natural dentition at an affordable cost and provide a viable alternative to the use of more invasive and expensive alternatives. These patients presented with complaints of pain and mobility in upper front tooth region following trauma. Diagnosis was confirmed on the basis of intra-oral periapical radiographs following which non-surgical root canal treatment was performed.

Horizontal root fracture accompanied by luxation of coronal fragment in a maxillary central incisor: a case report

Root fracture injuries affect up to 7% of permanent teeth. This type of injury is rarely seen in teeth with open apices and depending on the fracture site, the prognosis is good. This case report describes a horizontal intra-alveolar root fracture in the middle third of a maxillary central incisor associated with an extrusive luxation of the coronal segment and its treatment in a 6-year-old girl. The patient was observed under a regular follow-up regime. After 2 years, clinical examination showed normal tooth color and position, with a positive response to the pulp test.

Multidisciplinary treatment approach to restore deep horizontally fractured maxillary central incisor

This case report demonstrates sequential periodontic, orthodontic and prosthodontic treatment modalities to save and restore deep horizontally fractured maxillary central incisor. The location of fracture was deep in the mucosa which reveals less than 2 mm of tooth structure to receive the crown. The procedures like surgical crown lengthening, endodontic post placement, orthodontic forced eruption, core build-up and metal-ceramic crown restoration were sequentially performed to conserve the fractured tooth. Forced eruption is preferred to surgical removal of supporting alveolar bone, since forced eruption preserves the biologic width, maintains esthetics, and at the same time exposes sound tooth structure for the placement of restorative margins.

A review of root fractures: diagnosis, treatment and prognosis

Tooth fractures (crown or root fractures) are commonly encountered emergencies in a dental clinic. Root fractures are defined as fractures involving the dentine, cementum and pulp. They are broadly classified as horizontal and vertical root fractures. They may be clinically challenging cases to treat as, usually, treatment of such cases requires an interdisciplinary/multidisciplinary approach for complete rehabilitation of teeth. For a successful outcome, it is imperative to arrive at an appropriate diagnosis and design a treatment plan accordingly as soon as possible.This review article discusses the various types of root fractures, their diagnosis and treatment, along with the factors affecting their healing and prognosis.

CLINICAL RELEVANCE

Treatment of root fractures depends on a number of factors such as, position of fracture line, mobility of tooth and pulpal status. Thus clinicians must have thorough knowledge and adequate clinical experience to treat them properly.

Effectiveness of limited cone-beam computed tomography in the detection of horizontal root fracture

To compare the diagnostic accuracy of conventional film radiography, charge coupled device (CCD) and photostimulable phosphor plate (PSP) digital images and limited cone-beam computed tomography in detecting simulated horizontal root fracture. Root fractures were created in the horizontal plane in 18 teeth by a mechanical force and fragments were relocated. Another 18 intact teeth with no horizontal root fracture served as a control group. Thirty-six teeth were placed in the respective empty maxillary anterior sockets of a human dry skull in groups three by three. Intraoral radiographs were obtained in three different vertical views by utilizing Eastman Kodak E-speed film, CCD sensor, RVG 5.0 Trophy and a PSP sensor Digora, Optime. Cone beam CT images were taken with a unit (3D Accuitomo; J Morita MFG. Corp, Kyoto, Japan). Three dental radiologists separately examined the intraoral film, PSP, CCD and cone beam CT images for the presence of horizontal root fracture. Specificity and sensitivity for each radiographic technique were calculated. Kappa statistics was used for assessing the agreement between observers. Chi-square statistics was used to determine whether there were differences between the systems. Results were considered significant at P < 0.05. Cone beam CT images revealed significantly higher sensitivities (P < 0.05) than the intraoral systems between which no significant differences were found. Specificities did not show any statistically significant differences between any of the four systems. The kappa values for inter-observer agreement between observers (four pairs) ranged between 0.82-0.90 for the 3DX evaluations and between 0.63-0.71 for the different types of intraoral images. Limited cone beam CT, outperformed the two-dimensional intraoral, conventional as well as digital, radiographic methods in detecting simulated horizontal root fracture.

Root fracture of immature permanent incisors - a case report

This 7-year-old girl experienced pain in her upper central incisors following a fall to the ground. Radiographic examination revealed immature upper central incisors with mid-root oblique and horizontal root fractures. Splinting was performed. When at 3 months, an electric pulp test was positive for both injured teeth, and after 5 months, the fracture lines had disappeared on the radiographs, the splint removed. After 2 years, clinical examination showed normal tooth color and position, with a positive response to the pulp test. Radiographs demonstrated continuous root development, although root canal narrowing was noted at the healed fracture sites.

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.