This type of fracture involves the roots only: cementum, dentin, and pulp. Root fractures are not always horizontal; in fact, probably more often than not, the angulation of fractures is diagonal. One additional film angulation (foreshortened or 45 degrees) will, when combined with the standard 90- degree positioning,reveal most of the traumatic root fractures. If there is no mobility and the tooth is symptomless, the fracture is likely to be in the apical one-third of the root, and no treatment is necessary. If the coronal fragment is mobile, treatment is indicated. The initial treatment consists of repositioning the coronal segment (if it is displaced) and then stabilizing the tooth to allow healing of the periodontal ligament supporting the coronal segment.
Treatment
Treatment depends on level of fracture coronal, middle or apical thirdDiagnosis and Management First principles:
a) Reposition and rigid splint is a must.
b) Antibiotics contra-indicated
c)Lower rate of pulp healing with antibiotics.
No endodontic treatment initially, reassess over time and if there is pulp necrosis (usually only coronal fragment is affected) then:
i) Only treat to fracture line
ii) Long-term Ca(OH) 2 for hard tissue repair
The treatment also depends on the type of fracture.
Coronal Third Root Fractures
1)Orthodontic Extrusion
• Time consuming
• Prolonged retentive phase
• Should be followed by circumferential supracrestal fibrectomy
• The tissue and bone levels are most favourable
• No loss of root support
2)Crown Lengthening
• Surgical procedure involving flap elevation followed by osseous correction to provide enough biologic width for subsequent placement of restoration
• Loss of support due to osseous recontouring could lead to unfavourable crown root ratios.
3) Extraction and post extraction implant placement.
• Middle third root fractures
The amount of dislocation and the degree of mobility of the coronal segment affect the prognosis because the more severe the dislocation (and therefore the mobility), the less likely it is that fracture reduction can be accomplished, and also more likely it is that the pulp has been severely injured. If a tooth can be stabilized long enough for repair to occur, the location of the fracture is immaterial.
The treatment options are many:
1) Root canal therapy of both segments. This may be indicated in fracture cases when the segments are not separated, allowing passage of files and filling materials from the coronal segment across the fracture site into the apical segment .
2)Root canal treatment of the coronal segment only. This is the current recommendation, particularly with the view that the apical segment may contain vital, healthy pulp tissue .
3)Both segments are treated endodontically. Following root canal filling, a post space is prepared in the canal to extend from the coronal segment into the apical one, allowing placement of a rigid-type post (cobalt-chromium alloy) to stabilize the two root segments.Apical Third Root Fractures
Apical Third Root Fractures
These types of fractures very often need no treatment at all. At most if the tooth exhibits slight mobility then it might be necessary to use a physiologic splint for a week. In case of pulpal necrosis associated with such a tooth, Endodontic therapy followed by follow up is the course of action. Resection of the apical fragment may be the treatment of choice, only if apical infection persists after endodontic therapy.
Prognosis
Longitudinal fractures in the coronal and middle third have a poorer prognosis as compared to transverse fractures. Pulp canal obliteration is a common sequela.
Treatment
Treatment depends on level of fracture coronal, middle or apical thirdDiagnosis and Management First principles:
a) Reposition and rigid splint is a must.
b) Antibiotics contra-indicated
c)Lower rate of pulp healing with antibiotics.
No endodontic treatment initially, reassess over time and if there is pulp necrosis (usually only coronal fragment is affected) then:
i) Only treat to fracture line
ii) Long-term Ca(OH) 2 for hard tissue repair
The treatment also depends on the type of fracture.
Coronal Third Root Fractures
1)Orthodontic Extrusion
• Time consuming
• Prolonged retentive phase
• Should be followed by circumferential supracrestal fibrectomy
• The tissue and bone levels are most favourable
• No loss of root support
2)Crown Lengthening
• Surgical procedure involving flap elevation followed by osseous correction to provide enough biologic width for subsequent placement of restoration
• Loss of support due to osseous recontouring could lead to unfavourable crown root ratios.
3) Extraction and post extraction implant placement.
• Middle third root fractures
The amount of dislocation and the degree of mobility of the coronal segment affect the prognosis because the more severe the dislocation (and therefore the mobility), the less likely it is that fracture reduction can be accomplished, and also more likely it is that the pulp has been severely injured. If a tooth can be stabilized long enough for repair to occur, the location of the fracture is immaterial.
The treatment options are many:
1) Root canal therapy of both segments. This may be indicated in fracture cases when the segments are not separated, allowing passage of files and filling materials from the coronal segment across the fracture site into the apical segment .
2)Root canal treatment of the coronal segment only. This is the current recommendation, particularly with the view that the apical segment may contain vital, healthy pulp tissue .
3)Both segments are treated endodontically. Following root canal filling, a post space is prepared in the canal to extend from the coronal segment into the apical one, allowing placement of a rigid-type post (cobalt-chromium alloy) to stabilize the two root segments.Apical Third Root Fractures
Apical Third Root Fractures
These types of fractures very often need no treatment at all. At most if the tooth exhibits slight mobility then it might be necessary to use a physiologic splint for a week. In case of pulpal necrosis associated with such a tooth, Endodontic therapy followed by follow up is the course of action. Resection of the apical fragment may be the treatment of choice, only if apical infection persists after endodontic therapy.
Prognosis
Longitudinal fractures in the coronal and middle third have a poorer prognosis as compared to transverse fractures. Pulp canal obliteration is a common sequela.
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Prosthodontist in Mohali
Aw! It is really painful I guess. Root fractures should be treated immediately. If you don't event have an insurance, you can still save money by getting dental discount plans Pennsylvania .
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