Severe lateral luxation and root fracture: report of a case with 5-year follow-up

Abstract— A case of severe lateral luxation and root fracture in upper incisors is reported. Treatment involved the repositioning and fixation of the injured teeth and endodontic treatment with calcium hydroxide. The importance of long-term follow-up is emphasized.     

Management of intrusive luxation injuries

Abstract Traumatic intrusion of permanent teeth is a relatively infrequent but serious type of dental injury, cine to the complicated picture it involves. Various treatment approaches have been suggested, so far, regarding management of intrusive luxation. Techniques aiming to reposition the intruded tooth include observation for spontaneous reeruption, surgical as well as orthodontic repositioning. However, development of complications such as pulp necrosis, inflammatory root resorption, replacement resolution and ankylosis and loss of marginal bone support makes selection of the most favorable technique controversial. In this paper, a critical review of the existing treatment modalities is attempted and treatment approaches based on diagnostic parameters that are indicative of the severity of an intrusive injury are presented. Recommendations are made after taking into consideration experimental and clinical study findings and observations from other author's and our own clinical experience. Two cases of intrusive luxation in children are presented and management of the dental injuries as well as the complications which occured are being discussed.     

Successful minimally invasive intervention in a primary central incisor after root fracture: A case report

Root fractures vary in severity, extent, and location, according to the physical and mechanical aspects of the accident. Root fractures are rare in primary teeth and they affect dentin, cementum, periodontal ligament and the pulp. This paper reports a case of a two-and-a-half-year-old baby who had a root fracture of the upper right primary central incisor (tooth 51) as a consequence of trauma that was managed with minimally invasive intervention. After clinical and radiographic examinations, the presence of tooth mobility, pain, bleeding and a horizontal apical root fracture was diagnosed on tooth 51. The treatment of choice was splinting for 120 days, which can deliver excellent results regardless of the patient's age. The tooth was preserved without needing endodontic intervention until its physiologic exfoliation and normal eruption of its permanent successor. As sequelae to the fractured tooth 51, there was some coronal color alteration and dystrophic calcification of the root canal. This tooth did not develop ankylosis or mobility during the follow-up period. After 57 months of follow-up, repositioning and splinting were appropriate ways to manage this horizontal root fracture in the apical third of this primary tooth. It allowed the tooth to be preserved in the arch with normal function.     

Repair characteristics of horizontal root fracture: a case report

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.     

Repair of untreated root fracture: a case report

Abstract A case is presented in which an untreated root fracture in a maxillary central incisor of an adult male was found radiographically 10 years after injury. The tooth was removed and the area of the root corresponding to the fracture line was examined by SEM while the remaining tooth was processed for decalcified sections. Calcification of the coronal pulp associated with extensive tissue atrophy and normal pulp tissue apically was observed. Two barriers composed of dent in al and cemental hard tissue were present apically in the coronal fragment and in the fracture line.     

Partially arrested root formation in a permanent maxillary central incisor subsequent to trauma to the primary dentition

Abstract When the primary dentition sustains a traumatic insult, the development of the succedaneous teeth can be disturbed leading to a number of malformations. In this case report, the patient presented with a history of prior trauma to his primary maxillary incisors which resulted in partially arrested root formation for a permanent incisor. The considerations in formulating a treatment plan which included orthodontics are discussed.     

Conservative treatment of a cervical horizontal root fracture and a complicated crown fracture: a case report

Abstract This case report describes successful long-term conservative management of a cervical root fracture and a complicated crown fracture of the maxillary central incisors in a 12-year-old patient. A mineral trioxide aggregate partial pulpotomy was performed on the maxillary right central incisor, while the maxillary left central incisor was splinted to the neighbouring lateral incisor using an acid-etch technique. Both teeth remained asymptomatic throughout the 3.5 years of a review period, with the cervical root fracture having mostly healed with the formation of a calcified tissue between the fragments. Two different treatment methods were used for two different injuries that resulted in pulp preservation in both cases. This in turn has provided for normal root development to occur while also allowing for preservation of bone.     

Spontaneously healed root fracture: report of a case

Abstract  – Blows to the facial region can cause root fractures especially in anterior teeth. Fractures below the alveolar crest have a very high potential for healing and treatment consists of reduction and rigid splinting immediately after trauma. The aim of the treatment is to obtain reunion of the fragments. Although the fracture can heal spontaneously, the prognosis will not be as good as the correctly treated ones. The purpose of this paper is to report a case of spontaneously healed root fracture.     

Maxillary molar root fracture caused by sinus surgery: case report

Abstract A case is presented in which a horizontal root fracture of the mesiobuccal root of a maxillary first molar was diagnosed as the source of a patient's chronic pain. Horizontal root fractures arc rare in posterior teeth. The source of the fracture was determined to be trauma from access or curettage during two Caldwell-Luc sinus procedures. A detailed history and endodontic retreatment led to the diagnosis. A mesiobuccal root resection resolved the chronic pain.     

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.     

Repair of untreated horizontal root fracture: a case report

Abstract  – We report a clinical case of horizontal root fracture in the mandibular first premolar induced by a traffic accident. The fractured tooth spontaneously healed and diagnosed radiographically after 2 years. Fractured fragments were separated by a narrow radiolucent line and the edges were rounded, and healing of the tooth is likely to be related to interproximal connective tissue healing. Our case is an example of spontaneously healed fracture roots. An interesting finding is that the healing was observed even in the presence of two root canals, the vitality of the pulp was preserved and displacement of fragments were prevented.     

Treatment of a horizontal root fracture by vital root submergence

Abstract Cervical third horizontal root fractures in immature permanent teeth often present complicated and unpredictable treatment options. This case report describes the successful management of a horizontal root fracture in an open apex tooth by vital root submergence and subsequent nonsurgical root canal therapy.     

Multiple complicated crown–root fracture of a permanent incisor

Abstract –  The treatment of a transverse complicated and a vertical uncomplicated crown–root fractures with a horizontal root fracture of a maxillary right central incisor is presented. Coronal fragments were extracted atraumatically and gingivectomy was performed with electrosurgery to expose the subgingival fragment. The root canal was treated with calcium hydroxide to perform the healing at the fracture site. After the root fracture healing, a post was cemented into the canal and the coronal fragment was attached with a composite resin. Examination 18 months after treatment revealed good aesthetics and normal function.     

Pulpal healing after luxation injuries and root fracture in the permanent dentition

Abstract Pulpal healing patterns were studied in a clinical material of 637 luxated and 95 root-fractured permanent incisors followed routinely for up to 11 years. It was found that pulpal healing patterns could generally be divided into 3 groups according to the degree of injury sustained by the pulp: little, moderate or severe. Thus after luxation injuries, pulp survival could be without radiographic change (PS), with pulp canal obliteration (PCO) or nonhealing (pulp necrosis (PN)). After root fracture, similar healing patterns could be observed: healing by hard tissue union of fragments (HT), by connective tissue union of fragments (CT) or by nonunion due to interposition of granulation tissue between fragments (GT) resulting from PN of the coronal fragment. In both trauma situations, healing or nonhealing could be determined by type of luxation injury, stage of root development and type of fixation used (forceful application of orthodontic bands vs. passively applied acid-etch fixation). Pulpal healing complications (PN or GT) were based on clinical findings (coronal discoloration, loss of pulpal sensibility) and radiographic findings (resorption processes of the lamina dura at the root apex or at the level of the root fracture). However, in both injury groups the same changes could also be seen to be intermediate steps in the pulpal healing process. Based on findings from these studies, hypotheses for the mechanics of pulpal healing are proposed as well as guidelines for acute and later treatment of dental luxations, root fractures and the diagnosis of healing complications.     

Management of maxillary alveolar bone fracture and severely intruded maxillary central incisor: report of a case

Abstract –  An 11‐year‐old male who injured his maxilla and right maxillary central incisor and lip during a fall was presented to our hospital. His lower lip and upper gingiva were lacerated with swelling and epistaxis, and he had a maxillary alveolar bone fracture and severe intrusion of the right maxillary central incisor, which had penetrated the floor of the nasal cavity with avulsion. Under local anesthesia, we repositioned the incisor and bone segment and fixed them with a titanium micromesh plate and self‐tapping screws and splints. The incisor was also treated by root canal 3 days after the operation and was restored with a crown. We performed root canal filling 1 month later. Five months later, the plate and screws were removed. In prognosis of our case, no symptoms of inflammatory root resorption or ankylosis have observed for more than 1 year and 6 months of follow up based on both clinical and radiographic findings.     

Intrusive luxation: a case report

Abstract –  Intrusive luxation is one of the most severe types of dental trauma. The occurrence of pulp necrosis in intruded teeth with open apices is 100%. The risk of development of inflammatory or replacement root resorptions is high. Thus, endodontic intervention is required soon after the occurrence of trauma, in an attempt to prevent or delay the appearance of such lesions. On the other hand, the access to the root canal is difficult, as the crown is intruded. A multidisciplinary approach comprising Surgery, Orthodontics and Endodontics is required to allow exposure of the crown, orthodontic extrusion and onset of endodontic therapy. The patient GCSA, aged 15 years, attended the community project 'Lugar de dente é na boca' ('teeth should be in the mouth') of the Federal University of Goiás, Brazil, 1 week after complete intrusion of the right maxillary central incisor. Radiographic examination revealed that the incisal edge of this tooth was at the level of the crown-root interface of the adjacent teeth. After surgical exposure of the crown, pulp sensitivity was evaluated and was found to be negative. After onset of endodontic therapy, the patient was referred for orthodontic extrusion of the intruded tooth. Successive changes of root canal dressing were performed and the root canal was definitely obturated at 3 years and 6 months after onset of treatment. The present paper reports on a case of severe intrusive luxation, discusses the different treatments recommended for repositioning of traumatically intruded teeth, and questions the ideal period of maintenance of calcium hydroxide dressing in the root canal, in an attempt to prevent the occurrence of root resorption and repair any existing resorption.     

年轻恒牙挫入性损伤的处理策略

年轻恒牙挫入性损伤是预后最差的牙外伤类型之一,常导致牙齿缺失,影响患儿的美观及健康.治疗方案通常包括观察再萌出、正畸牵引复位和外科复位3种;临床上应根据患牙的牙根发育情况及挫入程度,参考患儿及家长意愿,选择单独或结合使用上述3种治疗方案进行治疗.治疗后的主要并发症包括牙髓坏死、牙根吸收、牙槽骨边缘性吸收、根管闭塞等.尽...     

Pulpal and periodontal reactions of immature permanent teeth in the dog to intrusive trauma

Abstract Pulpal and periodontal tissues of immature incisors of 10 dogs were radiographically and histopathologically evaluated immediately, 7, 15, 30 and 60 days after experimental intrusion induced by mechanical blows. Forty upper central and mesial lateral incisors showing incomplete root formation on radiographs were submitted to intrusive force. After the observation periods, the dogs were killed, two at a time. The hemi-maxilas were removed and processed for histopathologic examination. The traumatized teeth showed accelerated apical formation with reduced radicular length. Pulpal vitality was maintained and the subjacent tissues did not present irreversible changes. All traumatized teeth re-erupted spontaneously.     

Mandibular central incisor with two root canals

Abstract— A case report of a mandibular central incisor with two root canals and two separate apical foramina is presented. The tooth showed inadequate endodontic treatment and a periapical radiolucent lesion. The lesion healed following endodontic retreatment and proper obturation of both root canals.     

Spontaneously healed horizontal root fracture in maxillary first premolar: report of a case

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.