Published NewYork State Dental Journal November 2016 issue
INTRODUCTION:
Root fractures are traumatic injuries involving dentin,
cementum, and the pulp. Horizontal root fractures
commonly occur in the anterior maxillary region, and incisors with complete
root formation are the most affected teeth because of the elasticity of the
alveolar bone cavity (1).
The frequency
of root fractures in permanent teeth is only 0.5% to 7% out of which only 5% of
root fractures are found in mandibular incisors.Grossman (1974) said, “When
root fracture occurs in the middle or coronal third of the root the prognosis
is unfavourable because of the difficulty of immobilizing the tooth.”(2)
Proper management of
permanent incisors with horizontal rootfractures
includes careful diagnosis, continued re-evaluation and a conservative treatment
approach. The location of the rootfracture and
pulpal vitality status both play important roles in proper treatment decisions.
A thorough examination, judicious treatment and follow-up on the part of both
dentist and patient can result in long term retention of many of these
traumatized teeth.(3)
In 1958, Lindahl (4)
observed that root fractures could heal even after endodontic treatment of the
tooth. Basically, four types of conservative endodontic treatment have been
described: cleansing and gutta-percha (GP) filling of the root canal of the
coronal fragment only; cleansing and filling of the root canal in both
fragments; cleansing and GP filling of the root canal of the coronal fragment
and surgical removal of the apical fragment; and treatment of the root canal
with calcium hydroxide followed by filling with GP. (5,6,7)
In 1971, Andreasen (8,9)
reported healing of root fractures in nine of 14 teeth after treatment and root
canal filling of either just the coronal or of both fragments with GP. More
extensive studies of these types of treatment are lacking.
The following case
report present a conservative treatment approach to horizontal root fractures
in the cervical portion of mandibular central incisor, where gutta percha
filling of the root canal and splinting stabilized the root fragments and one
and half year follow up shows the healing of the fragments.
CASE REPORT:
A 32 year old female
patient reported to the Departmentof Conservative Dentistry and Endodontics one
month after dental trauma. The patient complained ofpain and mobility in the mandibularleft
central incisor. On intra oral examination, the toothwas grade 2 mobile and
tenderness on percussion waspresent (Fig. 1). An intra-oral periapical
radiograph revealed a cervical third horizontal root fracture in the mandibular
left central incisor (Fig. 2). Pulp vitality test showed that mandibular left
central incisor was non vital. So it was decided to splint the tooth followed
by endodontic treatment. The tooth 31 was splinted with resin and wire method
(Fig. 3). The patient was recalled after 4 weeks. At this timemobility was
reduced and the symptoms had ceased. After local anaesthesia, access cavity was
made.The canal was negotiated in both the fragments. Thebiomechanical
preparation was done with the help of Mtwo rotary file system and obturation
ofthe whole root canal was done with gutta percha andMTA Filapexsealer as a
single unit (Fig 4). The splint was removedafter 8 weeks. A review radiograph
taken 18 months after the initialaccident showed healing of the fracture sites
in tooth# 31 with hard tissue formation (Fig. 5).
DISCUSSION:
A variety of traumatic
conditions can cause root fractures, although the literature shows some
predominant causes such as falling while playing and running, during sports
activities, and blows received on the face.(10)
Root fractures
occurring in the cervical, middle or apical portion of the root may heal
spontaneously without any treatment. Additionally, the authors demonstrated
that following initial treatment without endodontic therapy by reduction and
stabilization, root fractures healed successfully.
The tooth in this case
was treated endodontically because we felt that the proximity of the fracture
line to the oral environment increased the possibility of contamination,
compromising the tissue repair.(11,12)
The prognosis for tooth
survival following a horizontal root fracture can be summarized as quite good.
Healing of the horizontal root fractures with or without initial treatment is
reported to occur in up to 70.80% of the cases.(13)
In the present case one
and half year after the injury, the endodontic treatment was considered
successful because the signs like clinical symptoms and abnormal mobility were
absent and moreover radiographic findings showed healing of fracture line.
Consequently, the
prognosis of root fractures depends on the extent of the fracture line, the
pulp tissue situation, occlusion, dislocation of fragments, and the general health
of the patient.(10)
CONCLUSION:
This article describes
the successful management of cervical third horizontal root fracture in
mandibular central incisor wherein stabilization of fractured fragments was
performed with gutta percha and sealer which united the fragments leading to
hard tissue formation in fracture site after one and half year.
REFERENCES:
1. Herwejier
J, Torabinejad M, Bakland LK. (1992). Healing of horizontal root fractures. J Endod;18:118
–22.
2. Block RM, Bushell A. (1977). Treatment of
horizontal mid-root fracture: a report of a case. Journal of the British Endodontic
Society, 10(1), 25-27.
3.
Benenati FW,
Biggs JT. (1994). Management of traumatized permanent incisor teeth with
horizontal root fractures. J Okla Dent Assoc. Fall;85(2):30-33.
4.
Lindahl B.
(1958). Transverse intra-alveolar root fractures. Roentgen diagnosis and
prognosis. Odont Revy;9: 10–24.
5.
Michanowicz AE.
(1963). Root fractures. A report of radiographic healing after endodontic
treatment. Oral Surg Oral Med Oral Pathol;16:1242–9.
6.
Michanowicz AE,
Michanowicz JP, Abou-Rass M. (1971).Cementogenic repair of root fractures. J Am
Dent Assoc;82:569–78.
7.
Cvek M. (1974).
Treatment of non-vital permanent incisors with calcium hydroxide IV.
Periodontal healing and closure of the root canal in the coronal fragment of
teeth with intraalveolar fracture and vital apical fragment. Odont Revy;25:239–46.
8.
Cvek M, Mejare
I, Andreasen JO. (2004). Conservative endodontic treatment of teeth fractured
in the middle or apical part of the root. Dent Traumatol; 20: 261–269.
9.
Andreasen JO.
(1971). Treatment of fractured and avulsed teeth. J Dent Child;29:45–8
10. Aras MH, Özcan E, Zorba YO, Aslan M. (2008).
Treatment of traumatized maxillary permanent lateral and central incisors
horizontal root fractures. Indian J Dent Res;19:354-6.
11. Zachrinsson BU, Jacobsen I. (1975). Long-term
prognosis of 66 permanent anterior teeth with root fractures. Scand J Dent Res;83:345–54.
12. Bender IB, Freedland JB. (1983). Clinical
considerations in the diagnosis and treatment of intra-alveolar root fractures.
J Am Dent Assoc;107:595–600.
13. Poi WR, Manfrin TM, Holland R, Sonoda CK. (2002).
Repair characteristics of horizontal root fracture: A case report. Dent
Traumatol;18: 98-102.
No comments:
Post a Comment