Prognosis of root-fractured permanent incisors

Abstract The prognosis of 56 root-fractured permanent incisors was evaluated clinically and radiographically for 2 to 31 years. Information about initial case histories, examination and treatment of root-fractured teeth were recorded retrospectively from patient cards. Most of the-root fractures occurred in the 16–20 year age group (38%) followed by the 11–15 year age group (29%). Males were involved more often than females. Fifty-two percent of the patients visited the dental clinic with in the first week, while 48% did so 1 month-31 years later alter the injury. The leading cause of root fractured injuries was falls (46%) and mostly involved one tooth (71%). Maxillary central incisors were the most often affected teeth (95%). The most common type of root fracture was in the middle third of the root (57%) followed by apical part (34%). About 59% of untreated or splinted teeth maintained their vitality. Healing with connective tissue was observed in 19 teeth, with calcified tissue in 15 teeth and with osseous tissue in only one tooth. There was partial or complete obliteration of the pulp space in these healed cases (62.5%). The formation of pulpal hard tissue produced no additional clinical problems. Partial or total pulp necrosis were noted in 21 (37.5%) teeth. Endodontic treatment was successful in 12 cases. The remaining 9 teeth were extracted due to the loss of marginal alveolar bone and apical periodontitis.     

Treatment of root-fractured maxillary incisor with Thermafil obturator

Abstract This case report describes the treatment of a maxillary left central incisor with intra-alveolar horizontal root fracture in the middle of the root. The pulp of the coronal segment was necrotic and endodontic treatment was performed. Instrumentation of the root canal through the fracture line was carried out and the tooth was obturated with Thermafil in order to bring about a union of the fragments. At the 24-month follow up examination the tooth was functionally and esthetically normal. Radiographically no pathosis was evident in the periapical or fracture areas.     

根管内加齿槽骨钛桩内固定即刻修复年轻恒前牙根折

目的：探讨年轻恒前牙根折内固定的新方法。方法：选取门诊外伤后2小时之内就诊的年轻患13例，17颗患牙，采用预制钛桩即刻行根管内加齿槽骨贯穿固定将断牙固定于原位。结果：13例患，共17颗患牙，经半年至3年的随访观察，成功15颗，失败2颗。结论：根管内加齿槽骨钛桩内固定即刻修复年轻恒前牙根折，方法简单可行，临床应用效果好。     

Survival of intentionally retained permanent incisor roots following crown root fractures in children

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.     

An investigation of replantation of traumatically avulsed permanent incisor teeth.

The success of treatment of 46 replanted, avulsed permanent incisors in 36 children was investigated in relation to some of the factors which have been reported to affect prognosis. Treatment was considered to have been successful if the tooth was still present in the mouth and required no further treatment. If more treatment was necessary, the outcome was considered to be uncertain, while if the tooth had been lost a failure was recorded. Treatment was considered to be successful for 21 teeth, uncertain for 20 teeth and a failure for 5 teeth. A significant relationship was found between success and the method of storing the avulsed tooth, with milk, saliva or saline being the best media. No relationship was demonstrated between the time the avulsed tooth was out of the mouth and success. Root resorption was the most frequent complication of replantation and occurred in 24 teeth. However, no significant relationship between resorption and the time that the avulsed tooth was out of the mouth was demonstrated.     

Prognosis of root-fractured permanent incisors — prediction of healing modalities

Abstract A population of 85 patients, comprising 95 root-fractured permanent incisors followed up to 11 years, was studied prospectively for the type of fracture healing that occurred (i.e. union of the fragments by interposition of hard tissue (HT) or connective tissue (CT), or nonunion characterized by interposition of granulation tissue between the fragments (GT)). Initial treatment was provided according to established treatment guidelines by the attending oral surgeon at the emergency room. Follow-up examination and treatment were provided by 2 of the authors. It appeared that GT could be diagnosed after approximately 3 weeks, while HT or CT could be diagnosed approximately 6 weeks after trauma. Many factors considered one at a time were found to have a significant or nearly significant effect on the type of fracture healing that occurred. However, a multivariate regression analysis revealed that the following factors were significantly related to fracture healing by HT: a large diameter of the apical foramen and severity of luxation of the coronal fragment (concussion/subluxation > lateral luxation > extrusion); fracture healing by CT: the presence of restorations in the injured teeth at the time of injury and the presence of marginal periodontal disease; and fracture nonhealing by GT: type of fixation (i.e. orthodontic band fixation versus acid etch or no fixation), antibiotic therapy, a constricted apical foramen, increased loosening of the coronal fragment, and stage of root development (GT never occurred in teeth with open apices). It was previously demonstrated following luxation injuries that type of luxation, stage of root development and type of fixation (orthodontic bands versus acid etch or no fixation) determined the prognosis of pulp survival. It therefore appears that the general factors that are able to predict the type of healing seen after root fracture are the same as those after luxation injuries, supporting the hypothesis that root fractures are another form of luxation injury, this time of only the coronal fragment.     

Root canal treatment of a root-fractured incisor tooth with internal resorption: a case report

A case is described in which root canal treatment with calcium hydroxide was used successfully to repair a fracture site with internal resorption of the tooth.     

Investigation of the children referred to a dental hospital with avulsed permanent incisor teeth

Abstract The management of children referred to a dental hospital because of avulsed permanent incisor teeth was considered in a retrospective study. The group consisted of 49 children between the ages of 6 and 14 years. Most of the children (60%) had their avulsed teeth stored dry while only 7% had them stored in milk, and 19% in saliva. Following avulsion the majority of the children attended a dental surgeon or general hospital. Twenty-three children contacted health care personnel within 30 minutes but only 13 had their teeth replanted in this time period. Thirty-six children had 46 incisors replanted. No relationship was demonstrated between the place or personnel who replanted the teeth, and a successful outcome.     

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.     

A retrospective evaluation of crown-fractured permanent teeth treated in a pediatric dentistry clinic

Abstract –  A retrospective study was carried out on the dental trauma records of 93 patients (55 boys, 38 girls) with 129 crown-fractured teeth. The patients' average age was 9.57 years (SD 1.57), ranging between 7 and 15 years. Uncomplicated crown facture (comprising enamel–dentin) was the most observed type of injury ( n  = 107, 83%). Only 15 patients (16.13%) sought treatment in less than 24 h following the injury. Of 41 injured teeth (31.79%) the apices were open at the time of presentation at the clinic. The initial treatment of these injured teeth were interim restoration with acid-etch and composite (69%), Cvek amputation (2.33%), fragment reattachment (1.55%), apexification (APX, 10.07%), and root-canal treatment (RCT, 17.05%). Out of 94 teeth, which were diagnosed as vital on admittance, 23 (24.46%) later developed pulp necrosis and required APX or RCT depending on their apical status. In 66 teeth (51.16%) definitive treatment was provided with only esthetic restoration (ER), while in 15.50% and 26.68% of injured teeth ER was carried out following APX and RCT, and RCT, respectively. Definitive treatment was provided in 3–6 months for 29.45% of the injured teeth, while 27.13% and 20.16% of teeth received definitive treatment within 1–3 months and 6 months to 1 year, respectively. Type of crown-fracture, elapsed time following injury, and vitality of the tooth on admittance and pulp necrosis observed were significantly related to the total time spent for definitive treatment ( P  < 0.05).     

Periodontal mechano-sensory responses following trauma to permanent incisor teeth in children

Abstract –  The aim of this study was to investigate mechano-sensory responses of injured and uninjured incisor teeth. Twenty-five children who had experienced dental trauma, together with age- and gender-matched controls, were studied prospectively. Touch thresholds of incisor teeth from both groups were determined using calibrated sets of von Frey hairs (force range 0.5–10.0 g in 0.5 g increments) using a forced choice staircase method. Forces were applied perpendicular to the buccal enamel surfaces along the midline, 2 mm from the incisal edge. Touch threshold was defined as the lowest force detected in three out of the five occasions. Following statistical analysis, P  < 0.05 was considered significant. At initial examination, the touch threshold values of 25 traumatised teeth were significantly greater than the untraumatised controls ( P  < 0.001), and these values approached those of the control teeth over 3–12 months ( P  > 0.05). Dental trauma was associated with increased touch thresholds in permanent incisor teeth, with recovery toward healthy control values usually occurring between 3–12 months.     

An unusual healing of a replanted permanent lateral incisor

Background:  Continued development and healing of an immature permanent tooth root was reported to have occurred. The continued viability of Hertwig's root sheath was thought to be necessary and responsible. Continued development of a tooth root separate from the body of the tooth was reported, but the initiation and development associated with a replanted tooth was not observed.
Methods:  A 9-year-old boy sustained an avulsion injury to his upper right lateral incisor. The tooth was replanted within 5–10 minutes of the incident and was splinted approximately 30 minutes after the injury, and then monitored for 2.25 years.
Results:  The periodontal tissues healed well. Root development was arrested with calcific deposit evident in the pulp canal. A radio-opaque structure, apical to the tooth root, was seen to develop on the radiograph 11 weeks after the initial trauma. The opaque mass continued to develop over the next two years of observation.
Conclusions:  Immature permanent tooth roots show remarkable reparative powers. Clinicians need to be vigilant and close continued monitoring of traumatized immature teeth is recommended.     

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

Abstract – The purpose of this study was to analyze tooth mobility changes in root‐fractured permanent teeth and relate this to type of interfragment healing (hard tissue healing (HT), interfragment healing with periodontal ligament (PDL) and nonhealing with interposition of granulation tissue (GT) because of pulp necrosis in the coronal fragment. Furthermore, the effect of age, location of the fracture on the root, and observation period on mobility values was analyzed. Mobility values were measured for 44 of 95 previous reported root‐fractured permanent incisors. Mobility changes were measured with a Mühlemanns periodontometer and noninjured incisors served as controls. The mobility values represented the labial‐lingual excursion of the root measured in μm when the tooth received a frontal and a palatal impact of 100 g force. In 18 cases of hard tissue healing (HT), a slightly increased mobility was seen after 3 months and 1 year, and a normalization of mobility value was usually found after 5 and 10 years. In 17 cases of PDL healing, generally a higher mobility was found in comparison with root fractures healing with hard tissue, and a consistent decrease in mobility value was found in the course of the 10 year observation period. A tendency for reduced mobility over time was found, a relation that could possibly be explained by the known general decrease in tooth mobility with increasing age. Finally, nine cases of nonhealing with initial interposition of granulation tissue (GT) because of pulp necrosis in the coronal fragment resulted in increasing mobility values possibly related to a lateral breakdown of the PDL in relation to the fracture line. In control teeth, a lowering of mobility was found over the course of a 10‐year observation period. In conclusion, mobility changes appeared to reflect the radiographic healing stages and known age effects upon tooth mobility.     

Diagnosis and treatment of pulp necrosis in permanent anterior teeth with root fracture

A follow-up study was made of 20 traumatized permanent incisors with pulp necrosis observed as a sequel to root fracture. The material included 19 patients aged 8–17 years (mean 11.6 years) at the time of injury. Negative response to electric stimulation was noted in 16 teeth from the first examination. In four teeth an initial positive response changed to negative within 2–9 months. The negative response was supported by additional signs and symptoms of necrosis in 19 teeth. Radiolucencies adjacent to the fracture line or coronal discolorations were the most important diagnostic factors. Discolorations occurred within 2 months, whereas radiographic changes in the fracture area took from 3 to .5 months. to develop. Four teeth were extracted without attempting endodontic therapy. Endodontic treatment confined to the coronal fragment was performed in 16 teeth. In most cases the canal was filled temporarily with calcium hydroxide until a closure at the fracture site was observed. Two apical fragments showing radiographic changes were surgically removed in conjunction with the permanent filling of the coronal fragments. During the postoperative observation period one tooth was extracted due to communication between the fracture area and the oral cavity. The treatment of the remaining 15 teeth was judged as successful after a mean observation period of 4.2 years, ranging from 2 to 5 years.     

Double permanent incisor teeth: management of three cases

Double teeth in the permanent dentition have a reported incidence of 0.1% for Caucasian groups. Common associated problems include adverse aesthetics, caries, periodontal disease, and malocclusions. Management can be challenging, often requiring a multidisciplinary approach. Three cases are presented illustrating the variety of treatments available.     

恒前牙根中部以下折断临床修复体会

目的：探讨根中部以下折断的恒前牙保存活髓或经根管治疗后进行功能修复的临床效果。方法：收集近5年来恒前牙根中部以下折断60位病例共178颗牙,根据情况进行保存活髓或根管治疗后加用根管钉或联冠形式进行功能修复。结果：经以上治疗,患牙均可收到较好的功能修复。结论：牙根中部以下折断应及时准确复位,定期监测牙髓活力,死髓牙应尽早作根管充填诱导硬组织屏障形成,经合适治疗后绝大部分患牙均可行使咀嚼功能。     

Use of a removable splint in the treatment of subluxated, luxated and root fractured anterior permanent teeth in children

Aim: The aim of this study was to evaluate the prognosis of subluxated, luxated and root fractured teeth in children treated by removable splints, designed to stabilize mobile anterior teeth and eliminate occlusal trauma due to malocclusion. Material and methods: A total of 227 traumatized anterior teeth (91 subluxated, 105 luxated and 31 root fractured teeth) treated with a removable splint were observed for 3 years. The traumatized teeth were from 79 children aged between 6–12 years (mean 8 years 5 months). If a traumatized tooth was extremely mobile, a fixed splint was first made before the impression was taken for the removable splint. Two weeks after completion of the removable splint treatment, an impression was taken again to evaluate the occlusal relationship of pre‐ versus post‐treatment of removable splint. Results: The treatment period with a removable splint averaged 3 weeks in subluxated teeth, 3–5 weeks in luxated teeth, 4–6 weeks in apical third root fracture injuries, and more than 5 weeks in middle third root fracture injuries. All the subluxated teeth and 74.1% of the luxated teeth maintained their pulp vitality during the 3‐year follow‐up period. Two of 21 (9.5%) apical third root fracture teeth and three of five (60%) middle third root fracture teeth had pulp necrosis in the coronal fragments. Internal resorption was not found in any of the traumatized teeth. External replacement resorption was not found in subluxated and luxated teeth. All the root fractured teeth displayed transient external resorption around the fracture lines. The surface resorption appeared to be self‐limiting and not to threaten the retention of the tooth. Inflammatory resorption was observed in teeth with pulp necrosis, but in all cases this was reversed with endodontic treatment. Eight of 23 (39%) apical third root fractured teeth displayed replacement resorption in their apical fragments, but the resorption was not serious enough to extract the tooth. No obvious alteration in the occlusal relationship was found comparing pre‐ and post‐treatment casts. The removable splints appeared to positively affect healing after traumatic injuries, as evidenced by the low number of complications at the 3‐year follow‐up period.     

Traumatic injuries of the permanent incisors in children in southern Turkey: a retrospective study

Abstract –  The aim of this study is to investigate the incidence, etiologic factors and results of dental trauma and the effects of age and gender on the trauma in permanent incisors. Over a 3-year period, 514 permanent incisor teeth in 317 patients with trauma history, who applied to Süleyman Demirel University School of Dentistry, Department of Pedodontics from the southern cities of Turkey, were evaluated. Standardized trauma forms were filled for each patient. In all age groups, the most frequent cause of trauma was found to be unspecified falls (47.6%). Maxillary teeth (88.5%) and central incisors (87.5%) were the most affected teeth from dental trauma. Ellis class II crown fracture was the most frequently seen type of injury (43.8%). The percent of the patients who applied to a dental clinic in the first 3 days after the trauma occurred (22.8%) was less than the percent of the patients who applied after 3 months and more time period (45.1%). It reveals that it is important to inform the public about dental trauma and the importance of time in these cases.     

Loss of upper permanent central incisor teeth. Case report

A case is reported in which elastic bands caused irreversible periodontal destruction around upper central incisor teeth. Every practitioner should be aware of the hazards associated with the use of elastic bands in minor tooth movement.