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.     

Double 'pink tooth' associated with extensive internal root resorption after orthodontic treatment: a case report

Abstract –  Advanced internal resorption affecting the crown of teeth may result in the appearance of a 'pink tooth', which, when located in the root canal, can perforate the external root surface. Therapeutically, this condition represents a clinical challenge and normally requires a combined endodontic and surgical focus. Presented herein are cases of double 'pink tooth' which appeared at different times after orthodontic treatment. In the most severe case, upon radiographic examination and computed tomography, the maxillary right central incisor presented an internal resorption, extending from the pulp chamber to the root middle third. After pulp removal, the debridement of the defect was performed using a 2.5% sodium hypochlorite solution, a #80 Kerr file, and an ultrasonic tip ST-17, aided by a surgical microscope. During the cleaning process, various sites of periodontal communication were identified. Upon controlling the hemorrhaging, the root canal was completely filled with White mineral trioxide aggregate. Within the 3-month follow-up treatment, a pink spot appeared on the maxillary left central incisor, which received conventional root canal therapy. Clinically and radiographically, over 18 months of follow up, both cases responded favorably to the proposed treatments. Therefore, it is important to monitor the patient due to the fact that pulp and periodontal sequelae can develop at varied moments after orthodontic treatment. Furthermore, with the current technology and biomaterials, it is possible to resolve cases with extensive internal perforating resorption through endodontic treatment.     

Management of intrusive luxation of maxillary incisors with dens in dente: a case report

Abstract – Intrusive luxation is one of the most severe types of dental traumatic injuries. The risk of occurrence of pulpal necrosis and inflammatory or replacement resorption is high. In an attempt to prevent or delay the appearance of such lesions, endodontic intervention is required soon after the occurrence of trauma. A 17‐year‐old boy reported to the Department of Conservative dentistry and Endodontics, KLE VK Institute of Dental Sciences, Belgaum, 2 days after a fall from a bicycle. Clinical and radiographic examination revealed an intrusive luxation of the left maxillary central incisor and lateral incisor. There were complicated crown fracture with the right maxillary central incisor and uncomplicated crown fracture with the left maxillary central incisor. Also, all the incisors showed the presence of Oelhers type II Dens‐in‐dente. The management was hence challenging. Immediate surgical repositioning was performed and the teeth were stabilized with a composite resin splint. Endodontic therapy was initiated with the right maxillary central incisor, and the canal was sealed with calcium hydroxide dressing. After 3 weeks, pulp sensitivity was repeated with the maxillary left central and lateral incisors. The result was negative. Considering the incidence of pulp necrosis and root resorption in intruded teeth with complete root formation, they also were dealt in a similar manner as the maxillary right central incisor. The splint was removed after 1 month. After 6 months of calcium hydroxide therapy, there was a satisfactory apical and periodontal healing. At this stage, the teeth were obturated and the fractures were restored with composite resin. A 1‐year follow up revealed a satisfactory clinical and radiographic outcome.     

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.     

Acute treatment of a concomitant horizontal root fracture and luxation of the coronal fragment of the right upper central incisor: a case report

Abstract – We report a case of a horizontal intra‐alveolar root fracture between the middle and apical third of the upper right central incisor associated with an extrusive luxation of the coronal fragment, in a 24‐year‐old male patient. Twenty minutes after being accidentally hit by a metallic device, the patient’s coronal portion was repositioned and splinted under local anesthesia. After that, we lost sight of the patient. One year later, the patient showed up. The splint was lost, the tooth showed physiological mobility and responded to pulp testing. Radiographs showed healing of the horizontal fracture and normal periodontal ligament.     

Management of a root fracture in an immature permanent tooth

A 9-year-old girl with trauma to the maxillary right permanent central incisor is reported. Clinically the tooth appeared extruded with one third of the root visible. The radiographic examination revealed a root fracture. The extruded tooth was repositioned and splinted with a heavy wire and adhesive resin, after which a resorbable collagen tissue was placed to cover the buccal region. Subsequent to the injury, swelling was observed and the patient complained of pressure pain in the periapical region of the tooth with no response to electric pulp testing. It was treated successfully with periodontal therapy and endodontic therapy with Vitapex.     

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.     

Use of MTA and intracanal post reinforcement in a horizontally fractured tooth: a case report

Abstract –  Root fracture is one of the consequences of dental traumatisms. The possibility of saving the fractured tooth depends on the level of the fracture and also on pulp vitality. This case report describes the use of MTA in association to an intracanal post to reinforce a maxillary central incisor with horizontal root fracture in its cervical third.     

Alternative treatment procedure in the case of fractured abutment of adhesive bridge: a clinical report

In this case report, an alternative approach was presented for treatment of coronal fracture including pulp of maxillary central incisor, one of the abutments of an adhesive bridge, by using fiber post and tooth's own fractured component. The patient was referred to our clinic with the complaint of pain from the upper right central incisor and mobility of the adhesive bridge in maxillary anterior segment. It was realized that, the upper right central incisor, one of the abutments of the adhesive bridge, had been fractured at middle thirds of the crown including the pulp chamber. After dismounting the adhesive bridge and completion of the root canal treatment, a fiber post was placed into the fractured tooth. The fractured component, adherent to adhesive bridge retainer, was concorded to the fiber post. The whole structure was cemented with adhesive resin. A 1-mm-wide groove was made along the fracture line and restored with composite resin. The patient was evaluated clinically and radiographically at 12 and 30 months after the treatment. CLINICAL SIGNIFICANCE: Adhesive cementation of fractured component by supporting the remaining tooth structure with a fiber post is an inexpensive and conservative treatment alternative when the fractured component is compatible with the remaining tooth structure in cases of tooth fractures including the pulp chamber at anterior segment.     

Endodontic Management of a Long-standing Horizontal Mid-root Fracture: Case Report in a Young Patient

The purpose of this case report was to present the successful endodontic management of a long-standing horizontal mid-root fracture in a permanent maxillary central incisor. A 12-year-old boy with a history of traumatic injury sustained 15 months previously to the maxillary central incisor presented for treatment. Clinical examination revealed physiological mobility, pulp chamber exposed to the oral environment, and the buccal mucosa with a sinus tract in the area of the traumatized tooth. A radiolucent lesion at the fracture line and apical fragment with obliteration of the root canal space were observed radiographically. Conservative root canal treatment of the coronal segment was performed using calcium hydroxide as an intracanal dressing. The calcium hydroxide was replaced every 8 weeks for 10 months. A hard tissue barrier was observed after this period, and the coronal fragment of the root canal was filled. After 4 years, the tooth was asymptomatic and functional and no periapical lesion was observed.     

Treatment of aggressive external root resorption with calcium hydroxide medicaments: a case report

Abstract –  Intrusive luxation is an injury involving the axial displacement of a tooth into the alveolar socket. This paper describes apexification using calcium hydroxide medicaments of an immature permanent central incisor in which spontaneous re-eruption as well as severe inflammatory external root resorption was observed following traumatic intrusion. A 10-year-old boy was referred to the Department of Pediatric Dentistry 3 days after having fallen at school. Intraoral examination revealed intrusive luxation and an enamel-dentin crown fracture of the maxillary left central incisor (Tooth 21). The tooth was not sensitive to percussion and responded positively to electric pulp test. Radiographic examination indicated that the tooth had an open apex and had been intruded approximately 3–4 mm relative to the cemento-enamel junction of the adjacent right central incisor. The tooth was left for possible spontaneous re-eruption. The crown fracture was temporarily restored using glass ionomer cement, and the patient was scheduled for recall in 2 weeks, at which time intraoral examination revealed spontaneous re-eruption of the tooth. However, radiographic examination also showed inflammatory external root resorption. The root canal was accessed and filled with a calcium hydroxide paste; however, follow-up examination indicated continuing resorption after 1 month. Calcium hydroxide plus points (CHPP) was chosen as an alternative treatment. At the end of 6 months of CHPP treatment, examination showed no further progression of external resorption and complete apexification of the tooth. After a 24-month follow-up period, no signs of pathosis were observed.     

Root fracture of immature permanent incisors – a case report

Abstract –  This 7-year-old girl experienced pain in her upper central incisors following a fall to the ground. Radiographic examination revealed immature upper central incisors with mid-root oblique and horizontal root fractures. Splinting was performed. When at 3 months, an electric pulp test was positive for both injured teeth, and after 5 months, the fracture lines had disappeared on the radiographs, the splint removed. After 2 years, clinical examination showed normal tooth color and position, with a positive response to the pulp test. Radiographs demonstrated continuous root development, although root canal narrowing was noted at the healed fracture sites.     

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.     

Repair of a horizontal mid-root fracture accompanied by labial luxation and partial alveolar fracture: a 21-year follow up

Abstract –  The prognosis of injured teeth involving horizontal mid-root fractures is poor and depends heavily on pulpal vitality, periodontal health and the repositioning of the tooth to its original position. Here, we report the case of an upper right central incisor presenting a horizontal mid-root fracture, complicated by impaction of the coronal fragment in the external alveolar bone, which in turn prevented the repositioning of the tooth fragment. As a consequence, it was necessary to raise a full-thickness flap and perform window-osteotomy to free the coronal fragment and reset the fractured fragment. Short-term follow up revealed pulpal vitality of the affected incisor and tissue repair at the level of the line of fracture, without any signs of periapical or periradicular pathology. In this paper, we describe some of the clinical features found upon revising this case 21 years later. The affected tissues are in good health, the root fracture is repaired and the pulp maintains its vitality.     

Root fracture in immature anterior teeth followed for 15 years

Abstract –  We report a case of injury to an immature tooth, observed over a period of 15 years. In 1987, a 9-year-old boy fell down in a schoolyard. The right central incisor demonstrated palato-version and radiographic observations revealed that the roots of both central incisors were incomplete. Further, a root fracture in the apical region of the central incisors was observed. During the first treatment visit, the right central incisor was repositioned and both teeth splinted. After confirming that the line of fracture was aligned, the fixation was continued for 2 months. The teeth were examined periodically for the next 15 years. Both teeth had favorable outcomes with continued root development of both the apical and coronal segments with good apposition of the fracture lines.     

Reattachment of subgingivally fractured central incisor with an open apex

Abstract –  A case report of a 6-year-old girl with a fractured maxillary left central incisor with an open apex is presented. The procedure used to repair the fracture included flap surgery with an intrasulcular incision and endodontic treatment. The patient was called for 3 months regular follow-up to check the root formation. At the end of 32 months just before the root was obturated by guttaperka, she fractured the same tooth. Flap surgery was repeated and the tooth was restored. The root canal was obturated with a root filling paste and guttaperka as the apex was closed. Examination 10 months after treatment revealed good periodontal health, aesthetics and normal function.     

Horizontal root fractures in permanent teeth: report of a case

Male patient, 9 years old 6 months who received an alveolodental traumatism is report: presents horizontal radicular fracture in right upper lateral and both central incisors with displacement of the lower segment of the lateral incisor out of the bone. Fragments were aligned and a splint made of wire and resin was placed for about 21 days. It was not necessary endodontic therapy, and was examined through a year. It was not evident any pulpar pathology or resorption and fragments joint.     

Is Pulp Regeneration Necessary for Root Maturation?

Introduction

True regeneration of the dental pulp-dentin complex in immature teeth with necrotic pulps has not been shown histologically. It is not known to what extent this true tissue regeneration is necessary to achieve clinically acceptable outcomes.

Methods

This case report describes the treatment of a patient with an immature maxillary right central incisor with a history of impact trauma and enamel-dentin crown fracture. A diagnosis of pulp necrosis with acute apical abscess was established. A regenerative endodontic protocol that used a paste containing Augmentin for 5 weeks as an intracanal medicament was used.

Results

Follow-ups at 9, 12, 17, and 31 months revealed complete osseous healing of the periapical lesion and formation of the root apex, but without increase in root length. Clinically, the tooth was functional, asymptomatic, and nonresponsive to pulp vitality tests. The crown discolored over time. On reentering the root canal, no tissues were observed under magnification inside the root canal space. The root canal treatment was completed with mineral trioxide aggregate obturation.

Conclusions

Augmentin might be an acceptable choice for root canal disinfection in regenerative endodontic procedures. The protocol for regenerative endodontic treatment is not predictable for pulp-dentin regeneration. Formation of the root apex is possible without pulp regeneration.     

Replantation and transplantation following avulsion of two maxillary incisors

Abstract –  Here we describe replantation and transplantation as a treatment conducted in a 16-year-old patient following a bicycle accident. An avulsed left central incisor in maxilla was replanted after extra-oral root canal treatment, and the lost right central incisor of the maxilla was replaced by a left lateral incisor of the mandible in the region of the fracture fissure. Follow-up examination at 34 months showed validity of treatment, although slight evidence of replacement resorption in the transplanted and replanted teeth was revealed.     

An intruded immature permanent incisor splinted with a mouthguard: A case report

An intruded upper left immature permanent central incisor of a 6-year-and-10-month-old girl was splinted with a mouthguard-type splint because the adjacent teeth could not be used for fixation. She visited our clinic about 1 h after she fell from an iron bar at school and injured her tooth. After repositioning, the incisor was splinted for 4 weeks with a mouthguard fabricated using the pressure molding technique. Although the incisor erupted in the normal position, a radiograph 1 year after the injury showed partial obliteration of the pulp cavity, and total obliteration was observed at 1 year and 10 months. The apical shape of the root was round and the root was shorter than that of the right central incisor. The incisor showed vitality 9 months after the injury using an electric pulp tester and the vitality equaled that of the right incisor at 1 year and 10 months. A mouthguard-type splint is less likely to cause ankylosis compared to rigid fixture and is useful for the fixation of an erupting immature incisor.