Spontaneous healing response of oblique root fracture: case report with 4-year follow-up

Hugo José Santos Bastos,Luiz Fernando Tomazinho,Marcos Roberto Dos Santos Frozoni,Élida Boaventura Mendes,Key Fabiano Souza Pereira

doi:10.33448/rsd-v10i3.13144

Abstract

Root fractures can involve the dentin, cementum, and pulp and commonly can occur as oblique fractures with varying orientations. The aim of this study was to demonstrate the maintenance of pulp health in a tooth with a fractured root without any endodontic treatment and to discuss the advantage of cone-bean computed tomography (CBCT) compared with traditional radiographs in the diagnosis of oblique root fractures. Intra-oral radiography of tooth 11 revealed a horizontal root fracture at the level of the apical third, while the sagittal CBCT slice reveals a complete fracture line running obliquely from the apical third on the buccal aspect through the cervical third on the palatal aspect. Four years follow-up, the tooth has kept its pulp vitality, no tooth discoloration or discrepancy in arch position, without endodontic treatment. This result illustrates spontaneous healing of root fracture including preservation of pulp health. In addition, it confirms the importance of exams in 3 dimensions to correctly locate the fracture and assist in the treatment decision.

Highlights

Transverse root fractures can occur as oblique fractures with varied orientations and initial diagnosis must be based on clinical findings and radiographic examination (Abbott et al, 2019)
cone-bean computed tomography (CBCT) imaging offers the advantage over intraoral radiography that the location, extent, and direction of a root fracture can be visualized in all three dimensions (Bornstein et al 2009, May et al 2013, Makowiecki et al 2014)
The sagittal CBCT slice of tooth 11 reveals a complete fracture line running obliquely from the middle third on the facial aspect through the cervical third on the palatal aspect, rather than the horizontal fracture that was diagnosed on periapical radiographs

Summary

Introduction

Transverse root fractures can occur as oblique fractures with varied orientations and initial diagnosis must be based on clinical findings and radiographic examination (Abbott et al, 2019). Intraoral radiography has been the technique most commonly used to detect root fractures. Oblique root fractures can be overlooked because of the beam angulation. CBCT imaging offers the advantage over intraoral radiography that the location, extent, and direction of a root fracture can be visualized in all three dimensions (Bornstein et al 2009, May et al 2013, Makowiecki et al 2014). Detection efficiency of the correct location and the type of root fracture are essential aspects in determining appropriate treatments. The splinting method with a certain flexibility of the splint are appropriate for teeth with luxation injuries and root fractures (Andreasen et al 2004)

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Conclusion