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Crowder L, Colloc T, Surendran S, McGregor S, Kilgariff J. Endodontic management of submerged roots following complicated traumatic dental injury (TDI) in children and adolescents: A systematic review. Int J Paediatr Dent 2024; 34:608-620. [PMID: 38282164 DOI: 10.1111/ipd.13161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 12/05/2023] [Accepted: 12/30/2023] [Indexed: 01/30/2024]
Abstract
INTRODUCTION The International Association of Dental Traumatology (IADT) guidelines include the use of decoronation for the management of complex crown-root fractures but do not outline how this technique is best employed. The aim of this review is to reach a consensus in the management of the root canal system in decoronated permanent teeth undergoing root submergence and to determine whether this has an impact on the success and survival of the retained root. MATERIALS AND METHODS Search included databases MEDLINE via Ebsco, EMBASE via Ovid, Web of Science via Clarivate, PubMed via PubMed.gov, the Cochrane Library via Wiley, cited reference searching and hand searching of relevant journals. Two independent reviewers performed study selection, data extraction and risk of bias assessment using Joanna Briggs Institute (JBI) Critical Appraisal Checklist. RESULTS AND DISCUSSION In total, 18 articles were included in qualitative analysis: 17 of these were case reports and one case series. A total of 37 teeth were treated with decoronation either using the Malmgren or an alternative protocol (root submergence following endodontic treatment with gutta-percha [GP] or a calcium silicate cement and vital root submergence). Limited evidence from this review suggests that immediate decoronation and vital root submergence are successful in apexogenesis and preserving alveolar bone. This systematic review has been registered in the International Prospective Register of Systematic Reviews (PROSPERO: registration number CRD42022316266).
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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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Sheridan BA, Freccia WF, Silvestrin T, Bakland LK. Treatment options for permanent teeth with coronal one-third root fractures. J Am Dent Assoc 2019; 150:213-218. [PMID: 30691689 DOI: 10.1016/j.adaj.2018.10.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 10/25/2018] [Accepted: 10/26/2018] [Indexed: 12/23/2022]
Abstract
BACKGROUND AND OVERVIEW Teeth with coronal one-third root fractures are considered to have a poor prognosis. Historically, such teeth were likely to be extracted. Observations have indicated that at least some teeth with such fractures can survive for a significant amount of time. CASE DESCRIPTIONS The authors report on 2 cases of coronal one-third root fractures that have survived for 10 and 35 years and suggest that the long-term splinting of these teeth aided in their survival. CONCLUSION AND PRACTICAL IMPLICATION Stabilizing teeth with coronal one-third root fractures may allow such teeth to survive for long periods, which can be of great benefit, especially for young patients.
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Ataol E, Erbaş Ünverdi G, Güngör HC. Management of cervical root fracture injury in a patient with epilepsy: Case report with 5-year follow-up. SPECIAL CARE IN DENTISTRY 2018; 38:319-323. [PMID: 29971831 DOI: 10.1111/scd.12304] [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: 03/23/2018] [Revised: 05/30/2018] [Accepted: 06/13/2018] [Indexed: 11/30/2022]
Abstract
The difficulty in providing stability to the coronal segment makes cervical root fracture one of the most challenging dental traumatic injury. This type of injury is less frequent in children. However, due to their serious consequences and poor prognosis, tooth loss may occur. This report presents the management of a case of cervical root fracture in an 11-year-old patient with epilepsy. The stabilization of the root-fractured tooth with a splint failed due to the recurrent seizures the patient had. Coronal fragment was removed and vital root submergence was performed in order to support the alveolar growth. The natural tooth crown was incorporated into a modified Nance appliance to meet the esthetic and functional requirements of the patient. After 5-year follow-up, this treatment approach has seemed to offer a long-term provisional and satisfactory solution to the consequences of a cervical root fracture injury.
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Affiliation(s)
| | - Gizem Erbaş Ünverdi
- Faculty of Dentistry, Department of Pediatric Dentistry, Hacettepe University, Ankara, Turkey
| | - Hamdi Cem Güngör
- Faculty of Dentistry, Department of Pediatric Dentistry, Hacettepe University, Ankara, Turkey
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Binus S, Koch A, Petschelt A, Berthold C. Restoration of endodontically treated teeth with major hard tissue loss--bond strength of conventionally and adhesively luted fiber-reinforced composite posts. Dent Traumatol 2012; 29:339-54. [PMID: 23171162 DOI: 10.1111/edt.12013] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2012] [Indexed: 11/28/2022]
Abstract
AIM To evaluate the influence of the luting system on the pull-out bond strength of conventionally and adhesively luted fiber-reinforced composite posts (FRCPs). MATERIAL AND METHODS One hundred extracted bovine teeth (Di 3) were endodontically treated and randomly assigned to nine test groups and one control group (n = 10) according to luting system. After preparing the post cavities (8 mm), the custom-made FRCPs were inserted using conventional glass-ionomer cement (Ketac Cem), resin-reinforced glass-ionomer cement (Meron Plus and Fuji Plus), self-adhesive resin cement (RelyX Unicem and BisCem), self-conditioning adhesive and resin cement [Multilink Primer + Multilink and AdheSE + DC Activator + MultiCore Flow, or etch-and-rinse adhesive and resin cement (SealBond Ultima + CoreCem, and LuxaBond + LuxaCore Z). As a control, custom-made titanium posts were inserted with Ketac Cem. After water storage (37°C, 24 h, dark), the pull-out test was performed, followed by failure mode evaluation. The data were statistically analyzed (α = 0.05) using analysis of variance and the Dunnett T3 post hoc test. RESULTS Luting system type and identity significantly influenced bond strength (P < 0.001); the bond strengths of all luting systems except Ketac Cem, MeronPlus, and BisCem were significantly higher than the control (4.4 ± 1.1 MPa). RelyX Unicem (12.0 ± 3.0 MPa) and LB + LCZ (14.8 ± 2.3 MPa) generated the highest bond strengths. The clinical application was demonstrated by restoring a traumatized tooth with extensive coronal destruction and thin root canal walls, using a FRCP combined with direct composite build-up. CONCLUSION Luting system selection significantly influenced the bond strength of conventionally and adhesively luted FRCPs to bovine root canal dentin.
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Affiliation(s)
- Stefanie Binus
- Dental Clinic 1 - Operative Dentistry and Periodontology, Friedrich-Alexander-University, Erlangen, Germany
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Westphalen VPD, de Sousa MH, da Silva Neto UX, Fariniuk LF, Carneiro E. Management of horizontal root-fractured teeth: report of three cases. Dent Traumatol 2008; 24:e11-5. [DOI: 10.1111/j.1600-9657.2008.00578.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Canoglu H, Gungor HC, Cehreli ZC. Management of cervical root fracture using orthodontic extrusion and crown reattachment: a case report. ACTA ACUST UNITED AC 2007; 104:e46-9. [PMID: 17709068 DOI: 10.1016/j.tripleo.2007.03.030] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2007] [Accepted: 03/23/2007] [Indexed: 10/22/2022]
Abstract
Root fractures involve damage to pulp, cementum, dentin, and periodontal ligaments. These injuries affect 0.5% to 7% of permanent teeth. Cervical root fractures are less frequently seen and have a worse prognosis compared with the fractures in the apical or middle third of the root. This case report describes the treatment of a cervical root fracture in a maxillary central incisor. After removal of the coronal fragment, the root was filled temporarily with calcium hydroxide and orthodontic extrusion was initiated. The remaining root portion was elevated above the epithelial attachment and a successful coronal restoration was made using the natural crown of the traumatized tooth.
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Affiliation(s)
- Harun Canoglu
- Department of Pediatric Dentistry, Faculty of Dentistry, Hacettepe University, Ankara, Turkey
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Demiralp B, Keçeli HG, Kökat AM, Muhtarogullari M, Tuncel B, Eratalay K. Multidisciplinary approach for the treatment of an oblique root fracture: a case report. Dent Traumatol 2007; 23:167-72. [PMID: 17511838 DOI: 10.1111/j.1600-9657.2005.00401.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
This clinical case study describes a multidisciplinary modified technique for the treatment of an oblique root fracture. A-38-year old woman with a history of trauma and a broken tooth was referred to our clinic. There was an oblique crown fracture extending the coronal third of the root just underneath the cingulum of the crown. The patient was willing to keep her tooth in function by any means. Two weeks after root canal therapy the flap was raised. The coronal two third of the root canal was enlarged. An impression of the enlarged root canal and tooth surface with surrounding bone was taken. The flap was sutured and the impression was sent to the laboratory for the post-casting preparation. After 7 days, the flap was opened again and casting was cemented. The flap was sutured. Ten days after the second surgery, three anterior teeth were prepared and a final impression was taken for the preparation of porcelain crowns. Restoration was finished 15 days after the second operation. The patient is still under maintenance therapy and the 12 month results are presented in this report. Extraction may not be the only alternative for the root fractures. Even for fractures under the alveolar margin, alternative multidisciplinary approaches can be used to restore and allow the tooth to survive.
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Affiliation(s)
- Burak Demiralp
- Department of Periodontology, Hacettepe University, Ankara, Turkey.
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Cobankara FK, Ungör M. Spontaneously healed horizontal root fracture in maxillary first premolar: report of a case. Dent Traumatol 2007; 23:120-2. [PMID: 17367460 DOI: 10.1111/j.1600-9657.2006.00575.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
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.
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Affiliation(s)
- Funda Kont Cobankara
- Department of Endodontics, Faculty of Dentistry, Selçuk University, Konya, Turkey.
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Olsburgh S, Jacoby T, Krejci I. Crown fractures in the permanent dentition: pulpal and restorative considerations. Dent Traumatol 2002; 18:103-15. [PMID: 12110103 DOI: 10.1034/j.1600-9657.2002.00004.x] [Citation(s) in RCA: 115] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Crown fractures account for the highest percentage of all traumatic injuries in the permanent dentition. This review paper will discuss the different types of crown fracture, from the uncomplicated to complicated, including crown-root fractures. It will focus on two different aspects: the pulp, with an attempt to correlate epidemiological, experimental, histopathological and clinical studies, so that the clinician can better understand the underlying processes accounting for success or failure to maintain pulp vitality. Also, we will consider the restoration: knowledge about bonding to dentin and new material is evolving extremely quickly making it difficult for the clinician to keep up with the developments. If handled properly, prognosis of the pulp, after traumatic crown fracture, is good. Prognosis of the restoration has also improved considerably over the last few years, and it appears that this trend will continue in the future.
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Affiliation(s)
- Steven Olsburgh
- Department of Operative dentistry, Endodontics and Pedodontics, University of Geneva, Geneva, Switzerland
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Rodd HD, Davidson LE, Livesey S, Cooke ME. Survival of intentionally retained permanent incisor roots following crown root fractures in children. Dent Traumatol 2002; 18:92-7. [PMID: 12184219 DOI: 10.1034/j.1600-9657.2002.180209.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Retaining tooth roots, following crown loss, confers a number of benefits including the preservation of alveolar bone. Intentional root retention in adults has been widely investigated but little is known about this treatment approach in children. Therefore, the aim of the present study was to investigate the clinical outcomes associated with permanent anterior root retention in a young population. The study group comprised 53 children who had received treatment in the paediatric dentistry clinic, Charles Clifford Dental Hospital, Sheffield, UK, over the past 10 years, following a complicated crown root fracture of a permanent maxillary incisor at or below the gingival margin. Data relating to patient age at crown root fracture, gender, previous trauma history, tooth vitality, treatments performed and clinical outcomes were obtained retrospectively using patient records. The mean age of the subjects at initial crown root fracture was 12.1 years (range 8.3-15.8 years) and there were more than twice as many males (n = 37, 70%) as females (n = 16, 30%). In just over half of the cases seen (n = 29, 54%), the tooth involved was already nonvital at the time of crown root fracture. For the majority of these nonvital teeth (n = 27, 93%), primary treatment had comprised placement/replacement of a calcium hydroxide root dressing. The remaining two teeth did not require root treatment as a satisfactory gutta percha root filling was already present. A variety of treatments was undertaken for the 24 vital roots: in 15 (63%) cases the pulp was extirpated and calcium hydroxide placed; three (12%) cases were subject to a pulpotomy; five (21%) cases were left untreated with the hope that vitality would be maintained following gingival healing and in one case the radicular pulp was extirpated and immediately obturated with gutta percha. The mean time that the roots were kept under review was 2.6 years (+/- 1.57, range 0.6-6.8). During this period, only five roots (9%) had to be removed due to persistent periapical infection. There were no complications associated with the five cases where vital root submergence had been permitted but all three cases which had initially undergone a pulpotomy subsequently presented with pulpal necrosis necessitating pulpal extirpation and calcium hydroxide therapy. These findings indicate that efforts to retain permanent anterior roots in a young population are justified in view of the high clinical success rate of over 90% over a 2-year period.
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Affiliation(s)
- Helen D Rodd
- School of Clinical Dentistry, University of Sheffield, United Kingdom.
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Poi WR, Manfrin TM, Holland R, Sonoda CK. Repair characteristics of horizontal root fracture: a case report. Dent Traumatol 2002; 18:98-102. [PMID: 12184220 DOI: 10.1034/j.1600-9657.2002.00071.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Radicular fractures in permanent teeth are uncommon injuries among dental traumas, comprising 0.5-7% of the cases. Fracture occurs most often in the middle-third of the root and rarely at the apical-third. The present paper reports a clinical case of a horizontal radicular fracture located between the middle- and apical-third of a upper left-central incisor followed-up for over 3 years. The tooth was extracted owing to periodontal reasons. Histomorphologically, it showed pulp-vitality preservation and root healing by hard-tissue deposition.
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Affiliation(s)
- Wilson Roberto Poi
- Department of Surgery and Integrated Clinic, School of Dentistry, The São Paulo State University-UNESP, São Paulo, Brazil.
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Abstract
These case reports describe a new treatment method for complete vertical root fractures. This method is composed of two steps. First, the fractured tooth is intentionally extracted atraumatically, and then the separated fragments are bonded with an adhesive resin cement. The restored tooth is replanted by rotating approximately 180 degrees into the original socket and fixing with an orthodontic wire. For both cases reported here, bone regeneration was observed at the 3-year follow-up. Since this modality adopts the respective advantages of both intentional replantation and adhesive treatment, it might be the treatment of choice in cases of vertical root fracture.
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Affiliation(s)
- Keiji Kawai
- Department of Restorative Dentistry and Endodontology, Suita, Osaka, Japan
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Abstract
Intra-alveolar root fractures of incisor teeth are more frequent than other dental injuries. These case reports describe two untreated horizontal root fractures of the maxillary right central incisors. Patients reported accidental trauma, which occurred several years ago. These fractures were discovered during a routine full-mouth radiographic survey. Teeth were asymptomatic and tested vital to electric pulp tests.
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Affiliation(s)
- M D Oztan
- Ankara University, Faculty of Dentistry, Department of Endodontics, Turkey.
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