Tooth mobility changes subsequent to root fractures: a longitudinal clinical study of 44 permanent teeth

Long-Term Outcome of Horizontal Root Fractures in Permanent Teeth: A Retrospective Cohort Study

INTRODUCTION

Horizontal root fracture (HRF) is a complex traumatic dental injury that affects the pulp, dentin, cementum, and periodontal ligament. This retrospective cohort study evaluated treatment outcomes in permanent teeth with HRF.

METHODS

We analyzed clinical and radiographic data from a dental trauma center (2006-2022). Permanent teeth with HRF with a follow up of ≥12 weeks were considered for outcome assessment (defined as clinical normalcy and radiographic healing at the fracture line). Prognostic factors were identified through multivariable logistic regression analyses (P value ≤ .05).

RESULTS

125 teeth from 103 patients were included. After a median follow-up of 79 weeks, the overall favorable outcome was 92%. This includes teeth that received emergency splinting/repositioning at baseline (62.2%) and those that received subsequent endodontic intervention for the coronal fragment (baseline: 85%; subsequent follow-ups: 91.8%). Being male and incomplete root development were both significantly associated with a better outcome of splinting/repositioning (OR = 2.58; 95% CI, 1.06-6.24 and OR = 4.37; 95% CI, 1.16-16.41, respectively) and a reduced likelihood of requiring endodontic treatment (OR = 0.44; 95% CI, 0.20-0.96 and OR = 0.24; 95% CI, 0.08-0.76, respectively). Treatment delays surpassing one week were significantly associated with an increased likelihood of requiring endodontic treatment compared to timely presentations within 24 hours (OR = 3.06; 95% CI, 1.07-8.77; P value < .05).

CONCLUSION

With timely diagnosis and treatment, and close monitoring, HRF cases can achieve a 92% favorable outcome. Male sex and incomplete root development correlate with improved baseline outcomes and a reduced need for endodontic treatment. Conversely, delayed presentation increases the likelihood of requiring endodontic intervention.

Present status and future directions: Endodontic management of traumatic injuries to permanent teeth

The prognosis of traumatized teeth depends largely on the fate of the pulp and its treatment. This review aims to update the present status on the endodontic management of traumatic injuries to permanent teeth and to identify relevant research areas that could contribute to an improvement in diagnosis and treatment of traumatized permanent teeth. Future research should pay greater attention to (1) diagnostic methods to assess the perfusion of the pulp and enhance detection of tooth cracks and initial signs of root resorption; (2) improved materials for vital pulp treatment; (3) studies focusing on type and duration of splinting after root fractures; (4) antiresorptive intracanal medication in case of posttraumatic pulp necrosis and infection-related resorption and (5) long-term data on the apical barrier technique compared to revitalization.

Conservative Non-Surgical Management of Horizontal Root-Fractured Maxillary Incisors in a Young Male with Angle Class II, Division 2, Malocclusion

Horizontal root fractures are a rare emergency in a dental office. The injury involves periodontal ligament, cementum, dentine and pulp. The healing is influenced by the location of the root fracture, the displacement of the fragments and the status of the pulp. This report presents a clinical case of horizontal fractures to both maxillary central incisors due to an act of violence. The type of occlusion has avoided a severe diastasis of the coronal parts with a subsequent damage to the pulp and periodontum. The fractures were treated with an orthodontic splint without any further therapy and hard tissue healing was observed. A careful diagnosis and well-timed treatment planning usually allow a cost-efficient and biologically-oriented therapy with a favorable outcome.

Effect of splinting times on the healing of intra-alveolar root fractures in 512 permanent teeth in humans: A Scandinavian multicenter study

BACKGROUND/AIM

Long-term splinting of teeth with intra-alveolar root fractures has been considered important for the deposition of hard tissue between the root fragments. The aim of this study was to compare the healing outcomes in teeth with intra-alveolar root fractures relative to splinting times in three dental centers in Scandinavia, using historical data.

MATERIALS AND METHODS

A total of 512 maxillary and mandibular incisors from three dental trauma centers were included in the study. Two of the centers used long-term splinting protocols of two to three months while the other center used a short-term splinting protocol of one month or less. Three outcomes were evaluated: (1) Healing with hard tissue (dentin and/or cementum). (2) Healing with connective tissue (periodontal ligament) interposition with or without bone between the fragments. (3) Non-healing due to the coronal pulp being necrotic and infected with granulation tissue interposed between the fragments.

RESULTS

The mean splinting times were 18, 81, and 110 days in the three centers. Long-term splinting resulted in hard tissue healing more frequently than short-term splinting. Short-term splinting resulted in more connective tissue/bony healing than long-term splinting, while there was no difference in the frequency of non-healing between long-term and short-term splinting protocols.

CONCLUSIONS

While the results suggest that long-term splinting favors hard tissue deposition, one cannot, however, conclude that long-term splinting definitely favors hard tissue healing since the treatment protocols were not randomized among the three centers. More clinical studies on the role of splinting time need to be done.

Dental prostheses and tooth-related factors

OBJECTIVES

This narrative review summarizes the current evidence about the role that the fabrication and presence of dental prostheses and tooth-related factors have on the initiation and progression of gingivitis and periodontitis.

FINDINGS

Placement of restoration margins within the junctional epithelium and supracrestal connective tissue attachment can be associated with gingival inflammation and, potentially, recession. The presence of fixed prostheses finish lines within the gingival sulcus or the wearing of partial, removable dental prostheses does not cause gingivitis if patients are compliant with self-performed plaque control and periodic maintenance. However, hypersensitivity reactions to the prosthesis dental material can be present. Procedures adopted for the fabrication of dental restorations and fixed prostheses have the potential to cause traumatic loss of periodontal supporting tissues. Tooth anatomic factors, root abnormalities, and fractures can act as plaque-retentive factors and increase the likelihood of gingivitis and periodontitis.

CONCLUSIONS

Tooth anatomic factors, such as root abnormalities and fractures, and tooth relationships in the dental arch and with the opposing dentition can enhance plaque retention. Restoration margins located within the gingival sulcus do not cause gingivitis if patients are compliant with self-performed plaque control and periodic maintenance. Tooth-supported and/or tooth-retained restorations and their design, fabrication, delivery, and materials have often been associated with plaque retention and loss of attachment. Hypersensitivity reactions can occur to dental materials. Restoration margins placed within the junctional epithelium and supracrestal connective tissue attachment can be associated with inflammation and, potentially, recession. However, the evidence in several of the reviewed areas, especially related to the biologic mechanisms by which these factors affect the periodontium, is not conclusive. This highlights the need for additional well-controlled animal studies to elucidate biologic mechanisms, as well as longitudinal prospective human trials. Adequate periodontal assessment and treatment, appropriate instructions, and motivation in self-performed plaque control and compliance to maintenance protocols appear to be the most important factors to limit or avoid potential negative effects on the periodontium caused by fixed and removable prostheses.

Dental prostheses and tooth-related factors

OBJECTIVES

This narrative review summarizes the current evidence about the role that the fabrication and presence of dental prostheses and tooth-related factors have on the initiation and progression of gingivitis and periodontitis.

FINDINGS

Placement of restoration margins within the junctional epithelium and supracrestal connective tissue attachment can be associated with gingival inflammation and, potentially, recession. The presence of fixed prostheses finish lines within the gingival sulcus or the wearing of partial, removable dental prostheses does not cause gingivitis if patients are compliant with self-performed plaque control and periodic maintenance. However, hypersensitivity reactions to the prosthesis dental material can be present. Procedures adopted for the fabrication of dental restorations and fixed prostheses have the potential to cause traumatic loss of periodontal supporting tissues. Tooth anatomic factors, root abnormalities, and fractures can act as plaque-retentive factors and increase the likelihood of gingivitis and periodontitis.

CONCLUSIONS

Tooth anatomic factors, such as root abnormalities and fractures, and tooth relationships in the dental arch and with the opposing dentition can enhance plaque retention. Restoration margins located within the gingival sulcus do not cause gingivitis if patients are compliant with self-performed plaque control and periodic maintenance. Tooth-supported and/or tooth-retained restorations and their design, fabrication, delivery, and materials have often been associated with plaque retention and loss of attachment. Hypersensitivity reactions can occur to dental materials. Restoration margins placed within the junctional epithelium and supracrestal connective tissue attachment can be associated with inflammation and, potentially, recession. However, the evidence in several of the reviewed areas, especially related to the biologic mechanisms by which these factors affect the periodontium, is not conclusive. This highlights the need for additional well-controlled animal studies to elucidate biologic mechanisms, as well as longitudinal prospective human trials. Adequate periodontal assessment and treatment, appropriate instructions, and motivation in self-performed plaque control and compliance to maintenance protocols appear to be the most important factors to limit or avoid potential negative effects on the periodontium caused by fixed and removable prostheses.

Treatment options for permanent teeth with coronal one-third root fractures

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.

Autogenous Tooth Fragment Adhesive Reattachment for a Complicated Crown Root Fracture: Two Interdisciplinary Case Reports

Trauma of anterior teeth is quite a common occurrence in both children and adults. Various degrees of trauma leading to fracture may affect teeth in different ways depending on the age of the patient and extent of fracture and other factors that will be discussed. Guidelines have been given as to how each of these situations should be treated. In the past, often more aggressive restorations were performed to restore fractured teeth. However improved and more efficient adhesion may affect the type of treatment we decide to carry out, leading to more conservative therapies through an increased preservation of tooth structures.

Root fractures: the influence of type of healing and location of fracture on tooth survival rates - an analysis of 492 cases

AIM

The purpose of this study was to analyze tooth loss after root fractures and to assess the influence of the type of healing and the location of the root fracture. Furthermore, the actual cause of tooth loss was analyzed.

MATERIAL AND METHODS

Long-term survival rates were calculated using data from 492 root-fractured teeth in 432 patients. The cause of tooth loss was assessed as being the result of either pulp necrosis (including endodontic failures), new traumas or excessive mobility. The statistics used were Kaplan-Meier and the log rank method.

RESULTS AND CONCLUSIONS

The location of the root fracture had a strong significant effect on tooth survival (P = 0.0001). The 10-year tooth survival of apical root fractures was 89% [95% confidence interval (CI), 78-99%], of mid-root fractures 78% (CI, 64-92%), of cervical-mid-root fractures 67% (CI, 50-85%), and of cervical fractures 33% (CI, 17-49%). The fracture-healing type offered further prognostic information. No tooth loss was observed in teeth with hard tissue fracture healing regardless of the position of the fracture. For teeth with interposition of connective tissue, the location of the fracture had a significant influence on tooth loss (P = 0.0001). For teeth with connective tissue healing, the estimated 8-year survival of apical, mid-root, and cervical-mid-root fractures were all more than 80%, whereas the estimated 8-year survival of cervical fractures was 25% (CI, 7-43%). For teeth with non-healing with interposition of granulation tissue, the location of the fracture showed a significant influence on tooth loss (P = 0.0001). The cause of tooth loss was found to be very dependent upon the location of the fracture. In conclusion, the long-term tooth survival of root fractures was strongly influenced by the type of healing and the location of the fracture.