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Saini A, Sharma S, Kumar V, Chawla A, Gupta S, Kahler B, Logani A. Cone-beam computed tomography-based descriptive classification for transverse root fracture. AUST ENDOD J 2024. [PMID: 38946250 DOI: 10.1111/aej.12867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 05/05/2024] [Accepted: 06/10/2024] [Indexed: 07/02/2024]
Abstract
Transverse root fracture (TRF) is classified as a cervical, middle or apical third root fracture on a periapical radiograph. The International Association of Dental Traumatology (IADT) suggests that cone-beam computed tomography (CBCT) should be considered, when conventional radiographs provide 'insufficient' information for diagnosis and treatment planning. Considering that CBCT can divulge additional information, it would be beneficial to have a clinically pertinent three-dimensional classification for TRF. The proposed alphanumeric classification includes the traumatised tooth number, describes the number of TRF, the facial and lingual location of each fracture line on the anatomic root, and its position relative to the crest of the alveolar bone. Further, diastasis, displacement of the coronal fragment and status of the alveolar bone at the site of TRF are also documented. This comprehensive classification system would provide a standard format for reporting, aid in referral communication and can be applied for future outcome studies on TRF.
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Affiliation(s)
- Aakriti Saini
- Division of Conservative Dentistry and Endodontics, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India
| | - Sidhartha Sharma
- Division of Conservative Dentistry and Endodontics, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India
| | - Vijay Kumar
- Division of Conservative Dentistry and Endodontics, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India
| | - Amrita Chawla
- Division of Conservative Dentistry and Endodontics, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India
| | - Shalini Gupta
- Department of Oral Medicine and Radiology, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India
| | - Bill Kahler
- Faculty of Medicine and Health, Sydney Dental School, University of Sydney, Surry Hills, New South Wales, Australia
| | - Ajay Logani
- Division of Conservative Dentistry and Endodontics, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India
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Liao WC, Chen CH, Pan YH, Chang MC, Jeng JH. Horizontal root fracture in posterior teeth without dental trauma: A diseased condition with special characteristics. J Formos Med Assoc 2022; 121:1625-1635. [DOI: 10.1016/j.jfma.2022.03.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 03/23/2022] [Accepted: 03/28/2022] [Indexed: 10/18/2022] Open
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Zheng P, Shen ZY, Fu BP. Conservative endodontic management using a calcium silicate bioceramic sealer for delayed root fracture: A case report and review of the literature. World J Clin Cases 2021; 9:1835-1843. [PMID: 33748232 PMCID: PMC7953412 DOI: 10.12998/wjcc.v9.i8.1835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 12/11/2020] [Accepted: 01/14/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The success rate of conservative endodontic management for root fracture varies greatly based on different methods used. It has been rarely reported that calcium silicate-based materials are applied in root fracture treatment.
CASE SUMMARY A 38-year-old male patient presented with spontaneous pain from the upper left anterior teeth for 1 wk. The spontaneous pain was subsequently relieved, but pain on mastication persisted for 3 d. The patient had a dental trauma from a boxing match 15 years ago. Cone beam computed tomography showed that the maxillary left central incisor had oblique fracture lines and a radiolucent lesion around the fracture line. The tooth was diagnosed with an oblique root fracture with no healing and symptomatic apical periodontitis. In the following conservative endodontic management, the coronal and apical fragments of the canal both were chemo-mechanically prepared and obturated using a single cone gutta-percha with iRoot SP (Innovative BioCreamix Inc, Vancouver, Canada), a new calcium silicate-based bioceramic root canal sealer. At follow-ups at 1, 6, 12, and 24 mo, the patient was asymptomatic and the radiolucency around the fracture line was healing radiographically.
CONCLUSION Conservative root canal treatment is an alternative treatment in some cases of oblique root fracture with no healing. The application of bioceramic sealers and single core obturation techniques may also be essential to obtain an excellent outcome.
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Affiliation(s)
- Pei Zheng
- The Affiliated Stomatology Hospital, Zhejiang University, Hangzhou 310006, Zhejiang Province, China
- School of Stomatology, Zhejiang Chinese Medical University, Hangzhou 310053, Zhejiang Province, China
| | - Zhen-Yu Shen
- School of Stomatology, Zhejiang Chinese Medical University, Hangzhou 310053, Zhejiang Province, China
| | - Bai-Ping Fu
- The Affiliated Stomatology Hospital, Zhejiang University, Hangzhou 310006, Zhejiang Province, China
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Cone-beam CT in paediatric dentistry: DIMITRA project position statement. Pediatr Radiol 2018; 48:308-316. [PMID: 29143199 DOI: 10.1007/s00247-017-4012-9] [Citation(s) in RCA: 138] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 09/11/2017] [Accepted: 10/11/2017] [Indexed: 01/05/2023]
Abstract
DIMITRA (dentomaxillofacial paediatric imaging: an investigation towards low-dose radiation induced risks) is a European multicenter and multidisciplinary project focused on optimizing cone-beam CT exposures for children and adolescents. With increasing use of cone-beam CT for dentomaxillofacial diagnostics, concern arises regarding radiation risks associated with this imaging modality, especially for children. Research evidence concerning cone-beam CT indications in children remains limited, while reports mention inconsistent recommendations for dose reduction. Furthermore, there is no paper using the combined and integrated information on the required indication-oriented image quality and the related patient dose levels. In this paper, therefore, the authors initiate an integrated approach based on current evidence regarding image quality and dose, together with the expertise of DIMITRA's members searching for a state of the art. The aim of this DIMITRA position statement is to provide indication-oriented and patient-specific recommendations regarding the main cone-beam CT applications in the pediatric field. The authors will review this position statement document when results regarding multidisciplinary approaches evolve, in a period of 5 years or earlier.
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Westphalen VPD, Carneiro E, Fariniuk LF, da Silva Neto UX, Westphalen FH, Kowalczuck A. Maintenance of Pulp after Horizontal Root Fractures in Three Maxillary Incisors: A Thirteen-Year Evaluation. IRANIAN ENDODONTIC JOURNAL 2017; 12:508-511. [PMID: 29225650 PMCID: PMC5722107 DOI: 10.22037/iej.v12i4.16617] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
This case report documents the clinical approach adopted for three upper incisors with horizontal root fracture in the middle or cervical third. The proposed procedures involved maintaining pulp vitality and periodontal stability of the fractured teeth with 13 years of follow-up.
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Affiliation(s)
- Vânia Portela Ditzel Westphalen
- Department of Endodontics, School of Health and Biosciences, Pontifícia Universidade Católica do Paraná, Curitiba, Paraná, Brazil
| | - Everdan Carneiro
- Department of Endodontics, School of Health and Biosciences, Pontifícia Universidade Católica do Paraná, Curitiba, Paraná, Brazil
| | - Luiz Fernando Fariniuk
- Department of Endodontics, School of Health and Biosciences, Pontifícia Universidade Católica do Paraná, Curitiba, Paraná, Brazil
| | - Ulisses Xavier da Silva Neto
- Department of Endodontics, School of Health and Biosciences, Pontifícia Universidade Católica do Paraná, Curitiba, Paraná, Brazil
| | - Fernando Henrique Westphalen
- Department of Oral Radiology, School of Health and Biosciences, Pontifícia Universidade Católica do Paraná and Department of Stomatology, School of Dentistry, Universidade Federal do Paraná, Curitiba, Paraná, Brazil
| | - Alexandre Kowalczuck
- Department of Endodontics, School of Health and Biosciences, Pontifícia Universidade Católica do Paraná, Curitiba, Paraná, Brazil
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Clinical management of horizontal root fractures aided by the use of cone-beam computed tomography. GIORNALE ITALIANO DI ENDODONZIA 2017. [DOI: 10.1016/j.gien.2017.05.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Differences in Healing of a Horizontal Root Fracture as Seen on Conventional Periapical Radiography and Cone-Beam Computed Tomography. Case Rep Dent 2017; 2017:2728964. [PMID: 28744379 PMCID: PMC5514331 DOI: 10.1155/2017/2728964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2017] [Accepted: 06/04/2017] [Indexed: 11/25/2022] Open
Abstract
Different locations and healing patterns of horizontal root fractures bear different prognoses. Conventional periapical radiographs have been routinely used for the evaluation of the locations and healing of horizontal root fractures, with the limitation of presenting two-dimensional images. The three-dimensional imaging technology, cone-beam computed tomography (CBCT), has recently gained interest in dental traumatology, in particular for locating and diagnosing root fractures. However, the assessment of healing patterns of horizontal root fracture using CBCT compared to conventional radiographs has not been established. This case report describes the different healing patterns evaluated by two-dimensional radiographs and CBCT of a horizontally root-fractured maxillary right central incisor treated with mineral trioxide aggregate (MTA) with a two-year follow-up. The findings suggest that the healing patterns of horizontal root fractures seen on conventional radiographs and CBCT may be different.
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Andreasen FM, Kahler B. Diagnosis of acute dental trauma: the importance of standardized documentation: a review. Dent Traumatol 2015; 31:340-9. [PMID: 26058528 DOI: 10.1111/edt.12187] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/22/2015] [Indexed: 11/30/2022]
Abstract
In 1985 Andreasen and Andreasen published a paper on the diagnosis of luxation injuries and outlined the importance of standardized clinical, radiographic, and photographic techniques. Now 30 years later, these recommendations remain current in the International Association of Dental Traumatology (IADT) guidelines for the management of dental trauma and describe circumstances surrounding the time of injury, the extent of trauma (e.g., type of luxation injury), healing potential (e.g., stage of root development) as well as information concerning subsequent treatment. The purpose of this review was to include findings for other types of trauma and to discuss more recent studies that augment and/or improve on the original findings from 30 years ago. The present review discusses the use of a standardized clinical registration (pulpal sensibility testing, laser Doppler flowmetry, mobility testing), radiographic survey, and photographic registration of the traumatized patient. Moreover, the value of digital radiographs and recent developments in computer tomography with respect to possible enhancement of the trauma diagnosis are discussed.
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Affiliation(s)
- Frances M Andreasen
- Research associate, University Hospital (Rigshospitalet), Dept. Of Oral and Maxillofacial Surgery, Copenhagen, Denmark.,Department of Primary Dental Care, Dental Institute, King's College, London, UK
| | - Bill Kahler
- School of Dentistry, University of Queensland, Brisbane, Qld, Australia
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