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.     

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.     

Repair of untreated horizontal root fractures: two case reports

Abstract – Intra-alveolar root fractures of incisor teeth are more frequent than other dental injuries. These case reports describe two untreated horizontal root fractures of the maxillary right central incisors. Patients reported accidental trauma, which occurred several years ago. These fractures were discovered during a routine full-mouth radiographic survey. Teeth were asymptomatic and tested vital to electric pulp tests     

Orthodontic movement of a horizontally fractured tooth: a case report

Abstract –  Intra-alveolar root fractures are relatively uncommon, and sometimes may be healed without treatment. Diagnosis of intra-alveolar root fracture is frequently made by exclusion of clinical signs of other traumatic injury, and by radiographic examination with films taken at different tube angulations. This case report presents a horizontal root fractured tooth that was healed satisfactory without treatment and moved orthodontically after prolonged time from trauma.     

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.     

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.     

上颌第一磨牙牙根折裂的临床特征分析

目的 探讨上颌第一磨牙牙根折裂的常见类型和方向以及根管治疗对牙根折裂好发部位的影响.方法 纳入274颗经锥形束CT(CBCT)诊断为牙根折裂的上颌第一磨牙,判读患牙的影像学特征,分别分析非根管治疗相关的原发性牙根折裂和根管治疗相关的继发性牙根折裂的好发部位、类型、方向及其差异.结果 在上颌第一磨牙原发性牙根折裂中,腭根...     

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.     

Rapid orthodontic extrusion of crown root and cervical root fractured teeth

Abstract This study concerns the relapse tendency and extent of root resorption in 33 extruded non-vital crown root fractured or cervical root fractured teeth in 32 patients 10–20 years old. They constitute all orthodontically extruded teeth at the Orthodontic or Pedodontic Departments, Eastman Institutet, Stockholm (1982–1987). A simple extrusion mechanism exerted a force of 60–70 p along the root axis of the tooth. An extrusion of 2–3 mm was obtained in most patients; the most extreme effect was 6 mm. In 16 patients the extrusion was achieved within 3 weeks, in 12 it lasted for 4–6 weeks and in 5, 7–9 weeks. The treatment was more complicated in the lower jaw. After the extrusion, a fibrotomy was done and in most patients also a gingival recon–touring to create an optimal relation between the gingiva and the margin of the restoration. Periodically identical radiographs were taken immediately before and after the extrusion, after 3 months and after 1 year. A minor relapse, about 0.5 mm, was observed in 3 patients. Limited root resorption was found in 6 teeth and severe in only 1. The resorptions did not progress in the following 2 years of observation.     

Resorption and mineralization processes following root fracture of permanent incisors

Abstract The records of 85 patients treated for 95 root fractures of permanent incisors and followed regularly for up to 11 years were studied with respect to healing events after injury. The radiographic exposure best suited for disclosing root fractures in the apical third of the root was a steep occlusal exposure, while a conventional bisecting angle periapical exposure was optimal for revealing fractures in the cervical third. It is concluded that both exposures should, therefore, be used at the initial examination at the time of injury. Root resorption processes were observed in 60% of the material and could usually be detected within one year after injury. These preceded fracture healing and obliteration of the apical and/or coronal root canals. The changes observed represented one or more of four resorption entities: 1) external surface resorption, characterized by the rounding of the fracture edges mesially and/or distally; 2) internal surface resorption, manifested as rounding of the fracture edges centrally, in the apical and coronal root canals, at the intersection between the pulp canal and fracture line; 3) internal tunneling resorption, going behind the predentin layer and burrowing along the root canal walls of the coronal fragment; and 4) transient apical breakdown of the apical lamina dura. While the resorption processes were self-limiting and required no treatment, the pattern of resorption and pulp canal obliteration appeared to be decisive for the type of fracture healing. Thus, all resorption entities collectively and internal tunneling resorption particularly were significantly related to healing at the fracture site by interposition of connective tissue. However, when seen alone, internal surface resorption was significantly related to fracture healing by hard tissue union. The different root resorption entities may represent osteoclastic activity connected with the ingrowth of new vascularized connective tissue into the fracture site or the coronal part of the root canal.     

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.     

Fracture of tooth by internal resorption: case report

Abstract A case of extensive internal resorption of the left mandibular first premolar in a 24 year old man is reported. The case presented with slight discolouration and mobility of the tooth. On radiological examination extensive internal resorption and a fracture line at the cemento enamel region was observed, separating the crown and root. The case was treated endodontically after surgical removal of the fractured fragment of the crown.     

Accuracy of three different electronic apex locators in detecting simulated horizontal and vertical root fractures

The aim of this in vitro study was to evaluate the accuracy of three electronic apex locators (EALs): Root ZX, Foramatron D10 and Apex NRG, in the detection of fractures in teeth having simulated horizontal and vertical root fractures. A total of 90 extracted intact, straight, single-rooted teeth were divided into six groups of 15 teeth each. In Groups A, B and C, an incomplete horizontal fracture was simulated by preparing a horizontal incision in the coronal, middle or apical portion of the root until the circumferential half of the canal was exposed in the horizontal plane respectively. In Groups D, E and F, an incomplete vertical root fracture was simulated by preparing a vertical straight incision to expose the canal in the coronal, middle or apical portion of the root all the way in the longitudinal plane respectively. The simulated fractures were 0.25 mm in thickness in all groups. The teeth were embedded in 1% agar and the canals were irrigated with saline solution during electronic measurement. Detection of the simulated root fractures was established with a size 10 K-file when the meter value reached 'APEX' on each EAL. In Groups A, B and C, Kruskal-Wallis tests revealed that there were no statistically significant differences between the three EALs. However, statistically significant differences were found among the EALs in Groups D, E and F (P < 0.0001, one-way anova and Tukey's post-hoc test). In conclusion, the three EALs tested were accurate and acceptable clinical tools in the detection of horizontal root fractures. However, the three EALs were unreliable in detecting the position of vertical root fractures.     

根折临床研究概况

牙根折断临床并不常见，但预后较差，为了能够尽量保存患牙，很多学者对其进行了大量的研究，本文对牙根折断的病因、诊断和治疗作一综述，为临床工作提供一定参考。     

35颗牙根纵裂的临床分析

目的 探讨牙根纵裂的原因、诊断及其预防方法。方法 对32例35颗患牙的临床表现及X线片进行临床分析。结果 牙根纵裂好发于中老年人第一磨牙的近中(颊)根，均有不同程度的咬合创伤及牙周炎。结论 咬合创伤是牙根纵裂的主要原因，X线检查有助诊断，牙根纵裂缺乏有效的治疗方法，应以预防为主。     

2种根尖定位仪诊断牙根纵裂的实验研究

目的研究Root ZX和Raypex5根尖定位仪是否能诊断牙根纵裂的存在及其准确位置。方法将20颗离体的双根管单根前磨牙拔髓并扩挫至根尖孔,测量原始根管的实际长度。锤击放置在根管内的根充扩大器柄部使牙根形成纵裂,测量纵裂根管的实际长度,并用Root ZX和Raypex5根尖定位仪测量仅有纵裂线而未完全分裂的纵裂牙根管长度和完全分裂的纵裂牙根管长度,对2种根尖定位仪的根管电测值与实际根管长度进行比较。结果模拟的牙根纵裂均为颊舌向裂,而且裂隙均通过根尖孔。对于仅有纵裂线而未完全分裂的纵裂牙根,Root ZX和Raypex5不能探测到纵裂位置;对于完全分裂的纵裂牙根,Root ZX和Raypex5都能探测到纵裂位置,电测长度在纵裂根管实际长度±1.0 mm范围内分别为97.5%、100%。结论根尖定位仪对仅有纵裂线的牙根纵裂无诊断价值,但对完全纵裂的牙根却有较高的诊断准确性。     

Crown-root fracture of lower molar – restorative procedures

Abstract Endodontically treated teeth may undergo crown, crown-root, or root fractures. The treatment of fractured teeth can be complicated, sometimes because of difficulties with the final restoration. This case report describes a case of crown-root fracture of a left lower first molar in which endodontic treatment and rapid orthodontic eruption of the tooth made a good prosthetic restoration possible.     

An investigation of root-fractured permanent incisor teeth in children

Abstract  – The aim of this retrospective study was to determine the type of healing which occurred in root-fractured permanent incisor teeth in children. The objectives were to determine whether gender, age, stage of root development or location of the fracture affected the healing type. The method involved careful scrutiny of clinical records and radiographs of children who attended a unit of paediatric dentistry in a dental hospital. Relevant information was entered onto a data collection sheet. The results were tabulated and analysed by the χ ²-tests using the SPSS statistical package. The results are based on 34 root-fractured teeth in 33 children aged 8–15 years. Root development was incomplete in 27 of the root-fractured teeth and complete in seven teeth. A good healing outcome was seen in 27 (79.4%) of the teeth and poor healing in 7 (20.6%). The only factor which was found to be statistically significantly related to healing was the stage of root development. It can be concluded that root-fractured teeth with immature roots have a better chance of showing good healing than teeth with mature roots.