Horizontal Root Fracture Research Articles

Immature Central Incisors With Horizontal Root Fracture:36 Months Follow-up

Immature Central Incisors With Horizontal Root Fracture:36 Months Follow-up

Immediate and late treatment of horizontal root fractures

Immediate and late treatment of horizontal root fractures

CT-Assisted Management with Biodentine Obturation and Aesthetic Rehabilitation of a Geminated Maxillary Central Incisor with Mid-Root Fracture: A Rare Case Report

Gemination, a rare aberration in tooth development, results from the incomplete division of one tooth germ into two. In this case report, a true geminated permanent maxillary central incisor tooth with a horizontal mid-root fracture is successfully treated by non-surgical endodontic treatment. To elucidate the intricate root canal anatomy of this rare geminated incisor, we employed computed tomography imaging technology, enhancing our understanding of this complex case. Utilizing biodentine for obturation proved pivotal, as its capacity to accelerate reparative dentin formation facilitated prompt healing, particularly beneficial in fracture cases. This was followed by aesthetic rehabilitation to achieve a pleasing mesio-distal dimension for both the central incisors using a zirconia-reinforced porcelain crowns. Keywords: Computed Tomography (CT), Gemination, Horizontal root fracture, Biodentine Obturation

Management of horizontal root fracture with root resorption at apical third using calcium silicate-based cement -A case report

Management of horizontal root fracture with root resorption at apical third using calcium silicate-based cement -A case report

Application of '10 Keys' Checklist and Partial Extraction Techniques to Optimize Esthetic Outcome for Adjacent Implants in the Esthetic Zone.

Placing immediate implants in the esthetic zone area poses significant challenges. Implants should be placed with consideration to hard and soft tissue management to optimize long term implant and cosmetic success. In this case report, two maxillary central incisors were extracted in two different time points, separated by 5 years because of horizontal root fractures. Implants were placed according to immediate single-tooth guidelines, using two different surgical and loading approaches, as risk assessment factors changed in the time between first immediate placement (#8) and second immediate placement (#9). These techniques included Partial Extraction Therapy (PET), the use of allograft and growth factors, connective tissue graft (CTG), platelet rich fibrin (PRF) and immediate and conventional loading. These were grouped as the '10 keys', a checklist used to pursue long term success. After 6-year and 1-year follow-up, radiographic and clinical results were satisfactory.

Incidental finding of a horizontal root fracture when considering a tooth for root canal treatment

A 44-year-old female patient was referred to the restorative department at Manchester University Dental Hospital for root canal treatment of the maxillary right lateral incisor, which appeared to have a sclerosed root canal. The tooth had a history of trauma when the patient was 6 years old. A cone beam computed tomography scan of the tooth revealed an incidental finding of a transverse root fracture that was otherwise not visible on the peri-apical radiograph. This highlights the diagnostic challenge of peri-apical radiographs and emphasizes the value of three-dimensional imaging in endodontics. It also highlights the importance of timely referral and management of traumatic dental injuries to reduce the risk of complications in the future. CPD/Clinical Relevance: This case report emphasizes the value of three-dimensional imaging in diagnosis.

Long-Term Outcome of Horizontal Root Fractures in Permanent Teeth: A Retrospective Cohort Study

IntroductionHorizontal root fracture (HRF) is a complex traumatic dental injury that affects the pulp, dentin, cementum, and periodontal ligament. This retrospective cohort study evaluated treatment outcomes in permanent teeth with HRF. MethodsWe analyzed clinical and radiographic data from a dental trauma center (2006–2022). Permanent teeth with HRF with a follow up of ≥12 weeks were considered for outcome assessment (defined as clinical normalcy and radiographic healing at the fracture line). Prognostic factors were identified through multivariable logistic regression analyses (P value ≤ .05). Results125 teeth from 103 patients were included. After a median follow-up of 79 weeks, the overall favorable outcome was 92%. This includes teeth that received emergency splinting/repositioning at baseline (62.2%) and those that received subsequent endodontic intervention for the coronal fragment (baseline: 85%; subsequent follow-ups: 91.8%). Being male and incomplete root development were both significantly associated with a better outcome of splinting/repositioning (OR = 2.58; 95% CI, 1.06-6.24 and OR = 4.37; 95% CI, 1.16-16.41, respectively) and a reduced likelihood of requiring endodontic treatment (OR = 0.44; 95% CI, 0.20-0.96 and OR = 0.24; 95% CI, 0.08-0.76, respectively). Treatment delays surpassing one week were significantly associated with an increased likelihood of requiring endodontic treatment compared to timely presentations within 24 hours (OR = 3.06; 95% CI, 1.07-8.77; P value < .05). ConclusionWith timely diagnosis and treatment, and close monitoring, HRF cases can achieve a 92% favorable outcome. Male sex and incomplete root development correlate with improved baseline outcomes and a reduced need for endodontic treatment. Conversely, delayed presentation increases the likelihood of requiring endodontic intervention.

Combination of metal artifact reduction and sharpening filter application for horizontal root fracture diagnosis in teeth adjacent to a zirconia implant.

This study examined the influence of metal artifact reduction (MAR), the application of sharpening filters, and their combination on the diagnosis of horizontal root fracture (HRF) in teeth adjacent to a zirconia implant on cone-beam computed tomography (CBCT) examinations. Nineteen single-rooted teeth (9 with HRF and 10 without) were individually positioned in the right central incisor socket of a dry human maxilla. A zirconia implant was placed adjacent to each tooth. Imaging was performed using an OP300 Maxio CBCT (Instrumentarium, Tuusula, Finland) unit with the following settings: a current of 8 mA, both MAR modes (enabled and disabled), a 5×5 cm field of view, a voxel size of 0.085 mm, and a peak kilovoltage of 90 kVp. Four oral and maxillofacial radiologists independently evaluated the CBCT scans under both MAR conditions and across 3 levels of sharpening filter application (none, Sharpen 1×, and Sharpen 2×). Diagnostic metrics were calculated and compared using 2-way analysis of variance (α=5%). The weighted kappa test was used to assess intra- and inter-examiner reliability in the diagnosis of HRF. MAR tool activation, sharpening filter use, and their combination did not significantly impact the area under the receiver operating characteristic curve, sensitivity, or specificity of HRF diagnosis (P>0.05). Intra- and inter-examiner agreement ranged from fair to substantial. The diagnosis of HRF in a tooth adjacent to a zirconia implant is not affected by the activation of MAR, the application of a sharpening filter, or the combination of these tools.

Interdisciplinary management of horizontal root fracture in middle third with osseous bone defect – A clinical report

Dental trauma are the main cause of emergencies in dental practice. Amongst these, root fractures are relatively uncommon but comprises about 0.5 to 7% of all injuries affecting permanent dentition. Most commonly, root fracture occurs from a horizontal impact mostly in oblique direction. The incidence is more common at the mid-third of the root rather at the apical and cervical thirds. Such hideous injury must be restored to normal as early as possible to retain the dental health and appearance. This report records the case of horizontal root fracture of upper anterior tooth, treated with Mineral Trioxide Aggregate (MTA) and fractured root fragments were unified with the aid of a stainless steel reamer after an endodontic treatment. Alloplastic bone graft and GTR membrane were used for osseous bone defect. Mineral trioxide aggregate (MTA) has several impending &amp; forthcomin clinical applications owing to its grander sealing property and biocompatibility. A 12 months follow-up revealed a well stabilized assembly of the root fragments and periodontal healing.

Influence of an adjacent zirconium implant, tube current, and metal artifact reduction algorithm on horizontal root fracture diagnosis in cone beam computed tomography

We evaluated the influence of an adjacent zirconium implant, tube current (mA), and a metal artifact reduction algorithm (MARA) on horizontal root fracture (HRF) diagnosis in cone beam computed tomography (CBCT). Nineteen teeth (9 with HRF, 10 without) were individually placed in a human maxilla. Scan volumes were acquired without and with a zirconium implant adjacent to the tooth at settings of 4, 8, and 10 mA, with MARA disabled and enabled, using a 5×5 cm field of view, 0.085-mm voxel size, and 90 kV. Four maxillofacial radiologists individually assessed the scans. Diagnostic metrics were compared by multiway analysis of variance (α=5%). Inter- and intraexaminer agreements for HRF diagnosis were evaluated with the weighted kappa test. Area under the receiver operating characteristic curve (AUC), sensitivity, and specificity were significantly lower in the presence of the implant (P≤.005). AUC values were higher in scans obtained with 8 and 10 mA compared with 4 mA (P=0.010), but 10 mA without MARA was better with the implant present. MARA did not significantly influence outcomes (P≥0.240). Inter- and intraexaminer agreements ranged from moderate to almost perfect. The presence of the zirconium implant impairs HRF detection. Settings of 8 or 10 mA improve HRF detection regardless MARA condition without the implant. With an adjacent implant, 10 mA without MARA is recommended to improve diagnostic performance.

Incidence and contributing factors of non-root canal treated teeth with chronic fatigue root fracture: A cross-sectional study

Chronic fatigue root fracture describes a root fracture in a non-root canal treated (non-RCT) tooth. This study aimed to report the incidence and contributing factors of non-RCT teeth with chronic fatigue root fracture in a Taiwanese population. This cross-sectional study included teeth extracted at Taipei Veterans General Hospital in Taiwan between 2018 and 2019. The reasons for extractions were recorded and included vertical and horizontal root fractures (VRF and HRF). Comparisons of clinical factors between teeth with fatigue VRF and teeth with fatigue HRF were performed by chi-square or Fisher exact test, where appropriate. Of the 4207 extracted teeth examined, 263 (6.25%) had tooth fracture. Thirty-two non-RCT teeth had chronic fatigue root fracture, including 16 with VRF and 16 with HRF. The incidence was 0.76% (32/4207). The occurrence of chronic fatigue root fracture was higher in males (83.9%). The mean age of the 31 patients with chronic fatigue root fracture was 71.7±13.1 years. More than half of these teeth had intact crowns with severe attrition. The fatigue VRF occurred more frequently in molars (P=0.003), in roots with a long oval cross-section (P=0.037), and in terminal teeth (P=0.013) than the fatigue HRF. The incidence of chronic fatigue root fracture is 0.76%. Both VRF and HRF occur mainly in aged males, in posterior teeth with attrition, and in teeth without restoration. Tooth position, cross-section root morphology, and terminal tooth are contributing factors related to chronic fatigue root fracture.

Root fracture in the permanent maxillary central incisors: a case report of 10 years follow-up

The objective of this case report is to present a 9-year-old female patient who suffered horizontal root fracture in the middle third of the two upper central permanent incisors. The teeth were splinted with composite resin in the proximal teeth involved in the trauma. After, the patient was referred to the pediatric dentistry clinic, where she received clinical and radiographic care for a period of ten years. Endodontic intervention was not necessary on both central incisors teeth. Tooth 11 healing by interposition of bone and connective tissue, and teeth 21 healing by interposition of connective tissue. After ten years, the teeth presented without any significant signs or symptoms requiring an invasive intervention. It is concluded that the patient's cooperation regarding care, oral hygiene and attendance at the return appointments, can be decisive for the success of the treatment.

Regenerative endodontic procedures for two traumatized mature anterior teeth with transverse root fractures

BackgroundRegenerative endodontic procedures (REPs) are an alternative treatment in immature traumatized teeth with necrotic pulp/apical periodontitis. However, this procedure has been infrequently reported in multiple transverse root fractures of mature teeth. This case report describes management of a patient with multiple horizontal root fractures in 2 maxillary central incisors that were successfully treated with REPs.Case presentationA 17-year-old girl had a history of traumatic injury to mature teeth 11 and tooth 21 resulting in multiple transverse root fractures. Clinical examination showed that both teeth responded to electric and thermal pulp sensibility tests with prolonged severe pain and were tender to percussion and palpation. Periapical radiographic examination showed both teeth were fully developed and had multiple transverse fractures in the mid-root. The pulp diagnosis was consistent with symptomatic irreversible pulpitis. REPs were initiated with only the coronal fragments treated to preserve pulp vitality in the apical fragment for potential pulp tissue regeneration. After REPs, clinical signs/symptoms subsided, and the two teeth were followed for 48 months when cone beam computed tomography (CBCT) imaging was also undertaken. At the last review, the case demonstrated root fractures healing with calcified tissue and pulp calcification in the apical fragments. Both teeth were stable and in function.ConclusionsREPs have the potential to be used to treat traumatized and symptomatic mature permanent teeth that have sustained transverse root fractures.

Treatment of horizontal root fracture with bioceramic cement: Case report

Horizontal root fractures involve cementum, dentin and pulp tissues, comprising between 0.5 and 7% of trauma cases that affect the permanent dentition. This paper aimed to report a case of horizontal root fracture, without immediate care, resulting from a car accident. Patient presented tooth 11 with darkening, coronary fracture and mobility grade two, in addition to negative responses to cold sensitivity tests and vertical and horizontal percussion tests. Through imaging exams, a horizontal fracture line was evidenced, with a local radiolucency. The treatment instituted was performed 12 years after the accident and consisted of endodontic treatment of the coronary fragment and its sealing with BIO-C® REPAIR bioceramic cement. Prompt care, correct diagnosis and adequate management of the case are important for a good prognosis of horizontal fractures. In the case reported, the treatment occurred in a mediate way, which may compromise the case prognosis. Close monitoring is essential to determine whether the therapy used was successful. Currently, the patient is asymptomatic.

Management of a complicated horizontal root fracture in a 12-year-old child using mineral trioxide aggregate: A case report

Root fractures occur more commonly in fully erupted permanent teeth with closed apices in which the completely formed root is solidly supported in the bone and periodontium. The consequences can be multifaceted because of collective damage to the pulp, dentine, cementum, bone, and periodontium. Management of horizontal root fractures depends on several factors, with the effect of various clinical modalities have been suggested. This case report describes the treatment of permanent maxillary right central incisors, treated with mineral trioxide aggregate (MTA) and follow up showed a successful treatment outcome.

Self-revascularization following horizontal root fracture with lateral luxation injury in a permanent maxillary central incisor

Repair or regeneration of the pulp, following trauma, is a part of the wound healing process. However, pulp necrosis or root resorption, whether partial or complete, might obstruct this process. Because of the neurovascular bundle at the apical foramen and the periodontal ligament, the pulp in this fragment generally remains normal when the apical fragment is not moved. We describe a mature upper left central incisor with a horizontal root fracture in the mid-third of the root and lateral luxation that healed on its own after undergoing a procedure called self-revascularization. The fracture was detected during a routine dental checkup on a tooth that was asymptomatic. Two tooth pieces with trabecular bone between them were discovered using periapical radiography and cone-beam computed tomography (CBCT). Therefore, the endodontic intervention was not needed. Regular follow-up after trauma is mandatory to evaluate any signs of pulp necrosis. CBCT can help assess healing and identify resorption.

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Root fractures are not common in permanent teeth. The rate of dental trauma is only 0.5-7%. It mostly occurs in the permanent teeth which are erupted fully, where the roots are fully formed and have closed apices that are supported by the periodontium. This trauma can lead to serious consequences like damage to periodontium, cementum, bone, dentine and pulp. They results due to horizontal impact and are transverse to obliquely direct. Mid third fractures of the root are the most common of all the fractures encountered. 2 persons with mid-third horizontal fracturesof root in upper lateral and central incisors are discussed here. After doing the root canal treatment (RCT), the fractured root was united by using glass fiber post. After finishing the treatment, metal ceramic crowns were placed on incisors. After 2 year follow up, the stabilized root parts and the post were observed Keywords:Fiber Splint; Glass Fiber Post; Healing; Horizontal Root Fracture; Intraradicular

Comparative evaluation of the vertical and horizontal root fracture resistance of primary maxillary incisors obturated with zinc oxide eugenol, vitapex, and endoflas: An in vitro study

Comparative evaluation of the vertical and horizontal root fracture resistance of primary maxillary incisors obturated with zinc oxide eugenol, vitapex, and endoflas: An in vitro study

: The Use of Mineral Trioxide Aggregate in The Treatment of Horizontal Root Fractures: A Case Presentation and Literature Update

Root fracture is a rarely seen traumatic injury in permanent dentition. It has a prevalence of 0.5-7 %. Tooth survival is significantly affected by the type of healing and the location of the root fracture. Additionally, the patient’s age, stage of root development, mobility and dislocation of the coronal fragment, and diastasis between fragments following this kind of injury are among the important factors.&#x0D; In this case presentation, the management with MTA plug and 6-year follow-up of a horizontal root fracture was reported. A literature update regarding the use of MTA in the management of horizontal root fractures was also added to discuss its merit.

Management of Oblique Root Fracture Using Mineral Trioxide Aggregate: A Case Report

Management of Oblique Root Fracture Using Mineral Trioxide Aggregate: A Case Report