Horizontal Root Fracture Research Articles

Comparison of bisecting and parallel intraoral radiography and cone-beam computed tomography for detecting various horizontal angle root fractures

Objectives The aim of this study was to compare cone-beam computed tomography (CBCT) with intraoral radiography (parallel and bisecting techniques) for their detection capabilities of various horizontal angle root fractures in human teeth.

Horizontal Palatal Root Fracture in a Vital Upper First Premolar

Root fractures in non–root-filled teeth occur mostly in maxillary incisors because of trauma. Horizontal root fractures in posterior teeth are rare. This case report describes a horizontal fracture of the palatal root of an upper first premolar in which the pulp was vital. The patient had no symptoms and had no initial recollection of trauma. The dentition showed signs of bruxing and occlusal erosion. Cone-beam computed tomographic imaging identified the affected root. The literature revealed only 2 previous examples of horizontal root fractures in posterior teeth in which pulps remained vital. The possible roles of trauma and bruxing in the etiology are evaluated. A tooth with a fractured root may remain vital and symptomless. The etiology of the fracture can be difficult to establish in posterior teeth. Cone-beam computed tomographic imaging can be invaluable in identifying the fractured root. Pulp sensibility testing is critical before intervention.

The Effect of Alteration of the Exposure Parameters of a Cone-beam Computed Tomographic Scan on the Diagnosis of Simulated Horizontal Root Fractures

IntroductionThe purpose of this study was to determine the effect of alteration of the exposure parameters of a cone-beam computed tomographic (CBCT) scan on the detection of the presence or absence of simulated horizontal root fractures (HRFs). MethodsCBCT scans of the lower incisor region of 5 human, dentate, dry mandibles were performed with 11 different exposure parameters. Ten teeth were extracted, and simulated HRFs were created near the apical thirds of the root. The fragments were reattached and the teeth replanted. The mandibles were rescanned over the same range of exposure parameters. Receiver operator characteristic analysis and kappa analyses were performed to assess diagnostic accuracy and intra- and interexaminer agreement for each scan setting. ResultsThe overall Az value (area under receiver operator curve) for the manufacturer's default setting was 0.95. The sensitivity was 0.94 and the specificity 0.96. A reduction in the tube current to 2 mA at 360° or 180° of rotation had no significant impact on the Az value, sensitivity, or specificity of CBCT imaging in the detection simulated HRFs. A reduction in the current to 1 mA at 360° or 180° of rotation significantly reduced the Az value (0.9 and 0.75, respectively) in comparison with the manufacturer's default setting (P < .05). ConclusionsCBCT scans are an accurate and reliable technique to detect HRFs. Within the limitations of this study, it is possible to reduce the radiation dose by altering the exposure parameters without a significant reduction in the diagnostic quality of the CBCT scan generated for the detection of HRFs.

Intraradicular splinting with endodontic instrument of horizontal root fracture.

Introduction. Root fractures, defined as fractures involving dentine, cementum, and pulpal and supportive tissues, constitute only 0.5–7% of all dental injuries. Horizontal root fractures are commonly observed in the maxillary anterior region and 75% of these fractures occur in the maxillary central incisors. Methods. A 14-year-old female patient was referred to our clinic three days after a traffic accident. In radiographic examination, the right maxillary central incisor was fractured horizontally in apical thirds. Initially, following local infiltrative anesthetics, the coronal fragment was repositioned and this was radiographically confirmed. Then the stabilization splint was applied and remained for three months. After three weeks, according to the results of the vitality tests, the right and left central incisors were nonvital. For the right central incisor, both the coronal and apical fragments were involved in the endodontic preparation. Results. For the right central tooth, both the coronal and apical root fragments were endodontically treated and obturated at a single visit with white mineral trioxide aggregate whilst the fragments were stabilized internally by insertion of a size 40 Hedstrom stainless-steel endodontic file into the canal. Conclusion. Four-year follow-up examination revealed satisfactory clinical and radiographic findings with hard tissue repair of the fracture line.

Influence of X-ray beam angulations on the detection of horizontal root fractures

Aims: The aim of this study was to evaluate the variation of vertical angle for detection of fractures. Materials and Methods: Twenty-five (25) single-rooted premolar teeth were divided into two groups, fractured teeth (n = 15) and non-fractured teeth (n = 10). Artificially fractured teeth were classified according to location, number of fragments, and direction of fracture line: Horizontal, oblique, or complex. The tooth fragments were juxtaposed with cyanoacrylate, and the specimens (fractured and non-fractured) were placed individually in the dental alveolus of a human jaw with the aid of silicone rubber impression material and submitted to eight periapical radiographs in a digital sensor with a vertical range of 10 degrees (−40, −30, −20, −10, 0, +10, +20, +30). Three examiners evaluated the characteristics of the fractures and their correlation with the radiographic diagnosis (perceived or not) by varying the vertical angle. Statistical Analysis: Descriptive analysis was performed through the analytical comparison and Kappa test inter-examiner. Results: Among the three examiners, inter-examiner Kappa value was 0.536. The radiographic identification of root fracture in the 15 prepared samples was 60% (nine) at angle 0, and at the angles of +10, −10, and −20, it was less than 50%. Conclusions: Multiple radiographs with variations of vertical angle are fundamental to facilitate the diagnosis of horizontal root fractures in premolars.

Prevalence of vertical root fracture as the reason for tooth extraction in dental clinics.

The aim of this study was to investigate the prevalence, by gender, of vertical root fracture (VRF) as the main reason for the extraction of permanent teeth in dental clinics in Tokyo. Participating dentists were requested to provide information about extractions of permanent teeth they had performed from 1 January 2013 to 30 June 2013. The main reasons for extraction were categorized as follows: VRF, caries (horizontal root fracture included), periodontal disease and others. At a total of 24 clinics, 736 teeth were extracted from 626 patients during the 6-month period. A total of 233 teeth were extracted by VRF (31.7%), and 93.6% of these were endodontically treated teeth. Among non-vital extracted teeth, 82.1% (179/218) had cast posts or screw posts. The percentage of extraction due to VRF was 29.4% in males and 34.7% in females. In females, the percentage of extractions due to VRF (34.7%) was higher than for periodontal disease (28.1%). In males, the percentage of extractions due to VRF increased with age (p < 0.05). The tooth types with the highest percentage of extractions due to VRF were the upper canine (46.7%), lower second premolar (48.0%) and lower first molar (50.0%) in males and the upper first premolar (43.3%), upper second premolar (44.4%), lower second premolar (53.8%) and lower first molar (54.5%) in females. These results indicate that we need to pay more attention to maintaining vital teeth while being aware of the particular tooth types in which VRF most frequently occurs.

The value of cone beam computed tomography in detecting suspicious vertical root fractures of molars on periapical radiographs

To evaluate the diagnostic accuracy of the cone beam computed tomography (CBCT) in detecting suspicious vertical root fractures (VRF) of molars on periapical radiography. Forty-five teeth of 45 patients with clinical signs and symptoms suggestive of VRF but not confirmed by periapical radiographs were collected. All of these 45 teeth accepted the examination of CBCT and were extracted for conceivable bad prognosis. All these teeth were extracted by minimally invasive surgery, and the conditions of the roots were observed to make sure the VRF happened or not before extraction. Nine teeth were excluded post operation because of fragmented and horizontal root fracture. Thirty-six teeth were included in this study. Two dentists observed the CBCT images of the teeth independently and reached a consensus. Diagnosis test was performed in this study. The sensitivity, specificity, and accuracy of the CBCT in detecting VRF were 72.4%, 91.8% and 84.6%. The positive predictive value and negative predictive value and Youden index were 84.0%, 84.9% and 0.642 respectively. CBCT should be used in diagnosing VRF in those cases which could not be confirmed by clinical signs, symptoms and periapical radiographs. But for those cases with metal restorations were not recommended for further CBCT examination.

Posttraumatic Use of Dental Implants Immediately After Tooth Extraction

Root fracture is a combined injury of cementum, dentin, and pulp. Many of these traumas remain untreated, mistreated, or overtreated. It leads to a more complicated treatment in case of tooth loss. Many different treatment procedures, with a very changeable success rate, have been proposed for years to treat teeth with root fractures. The objective of the following clinical studies was to evaluate the clinical effectiveness of implants placed in fresh extraction sites to treat teeth with horizontal root fracture. The study group included 25 patients (15 men and 10 women) between the ages of 20 and 65 years. After an initial examination and a treatment planning, all of the patients underwent periodontal treatment, which was deemed necessary to favor wound healing. All the 25 teeth were extracted because of horizontal root fracture located at the level of the middle third. The second-stage surgery was performed 6 months after the initial procedure. The following clinical parameters, presence or absence of mobility, presence or absence of pain, and presence or absence of suppuration, were evaluated in each patient at 6 and 12 months after implant placement. Radiographs were taken using the standard method to evaluate the marginal bone loss. The healing period was uneventful for all patients. All implants had osseointegrated. After 12 months, patients were asymptomatic and showed no signs of infection or bleeding when probed. On the basis of this study, implants placed right after tooth extraction are a valid treatment procedure, which induces predictable results as treatment of fractured teeth.

The effect of voxel size on the identification of vertical and horizontal root fractures by cone beam computed tomography: an in vitro study.

The effect of voxel size on the identification of vertical and horizontal root fractures by cone beam computed tomography: an in vitro study.

Influence of Cone-beam Computed Tomographic Scan Mode for Detection of Horizontal Root Fracture

IntroductionThe purpose of the present study was (1) to test the accuracy of a small-volume cone-beam computed tomographic (CBCT) device in detecting horizontal root fractures (HRFs) in teeth with and without an intracanal metallic post (IMP) and (2) to investigate the use of 2 different acquisition protocols of a CBCT device for HRF diagnosis. MethodsForty endodontically treated teeth with and without an IMP were examined using PreXion 3D CBCT scanner (Terarecon, San Mateo, CA) with a 5-cm high and 5-cm diameter cylinder at 0.10-mm voxel reconstruction. Two observers analyzed the samples to determine the presence and location of HRFs. ResultsSensitivity values ranged from 0.40–0.80. The most favorable results were found for the samples with no IMP observed using the protocol of a higher number of x-ray projections (0.70–0.80). Accuracy in the groups with an IMP ranged from 75%–90% in the 1024 x-ray projection protocol (HI-HI group) versus 70%–85% for the same samples examined in the 512 x-ray projection protocol (HI-STD group). Intraobserver agreement ranged from relevant to perfect concordance for both protocols (HI-HI = Kappa: 0.60–1.00 and HI-STD = Kappa: 0.55–0.89). Interobserver agreement ranged from moderate to perfect concordance for both protocols (HI-HI = Kappa: 0.79–0.89 and HI-STD = Kappa: 0.42–0.76). ConclusionsEven though there are statistically significant differences for the protocol with the higher number of x-ray projections, we found high accuracy, sensitivity, sensibility, and intra- and interobserver agreement in detecting HRFs for both Prexion 3D protocols.

The use of MTA/blood mixture to induce hard tissue healing in a root fractured maxillary central incisor. Case report and treatment considerations

To report the use of MTA/blood mixture for the induction of hard tissue healing of multiple horizontal root fractures in a maxillary incisor. An 18-year-old male patient was referred after suffering trauma to the anterior maxilla. Radiographic evaluation revealed multiple horizontal fractures in the middle and cervical third of his maxillary right central incisor. Clinical evaluation revealed third grade mobility of the coronal segment. The patient's accompanying radiographs revealed that root canal treatment of all segments had been previously initiated and both segments had been rendered pulpless. The coronal segment was repositioned and stabilized. A bi-antibiotic mixture, containing equal parts of ciprofloxacin and metronidazole, was used for the disinfection of the root canal segments. A blood clot was induced from the periapical area and MTA powder was mixed with the blood creating a bioceramic mixture covering all the fractures. Thick MTA was placed as a coronal barrier and the tooth was restored. Recall examination after 24months revealed healing of the horizontal fractures. The MTA mixed with the blood lost its radio-opacity over time. Tooth mobility returned to normal limits. A low range of 5-25% of all horizontally root fractured cases develop pulp necrosis, confined in the coronal segment, leaving the apical segment with vital tissue. In the unfortunate situation that the pulp of both segments becomes necrotic or the entire pulp tissue is removed, the use of MTA/blood mixture may be beneficial for the induction of hard tissue healing. MTA when mixed with blood seems to lose its radio-opacity over time.

Treatment of maxillary left central incisor with horizontal root fracture - A case report

Traumatic injuries of teeth are the main cause of emergency treatment in dental practice. Horizontal root fractures are more frequently observed in the maxillary anterior region and young male patients. The most common type of root fracture is in the middle third, followed by apical, and coronal part. This case report describes treatment of single horizontal root fracture in maxillary left central incisor by surgically removing the fractured fragment of the root followed by retrograde filling with MTA.

Multidisciplinary treatment approach for horizontal root fractures

The aim of this case report is to present a multidisciplinary treatment plan for horizontal root fracture of maxillary anterior teeth that resulted from trauma. A 16-year-old male presented a horizontal root fracture in the middle-third of teeth 11 and 21. Dislocated tooth fragments were repositioned using a composite splint technique. Follow-up examinations revealed the teeth lost vitality after trauma. Separated tooth fragments were removed by a surgical operation and then reattached using fiber post and resin cement. Teeth were replanted into the alveolar socket and splinted after root canal treatment. After 1 year of follow-up examinations, this comprehensive treatment was observed to be successful both clinically and radiographically. Horizontal root fractures can be treated successfully by extraoral reattaching of fractured segments and intentional replantation of teeth after root canal treatment.

Managment of complex crown root fracture using fibre post - A case report

Coronal fractures of permanent dentition are the most common type of dental injury. If the original tooth fragment is available following fracture, the natural tooth structures can be reattached using adhesive protocols. The development and use of fiber-reinforced composite root canal posts make possible the reattachment of the crown esthetically and reinforce the bonding of teeth fragments to the remaining natural teeth. Root fracture is one of the consequences of dental trauma. Horizontal root fractures are unfortunate accidents that most of the times affect the maxillary central incisors mainly in the middle third of the root nevertheless apical and coronal third fractures are also sometimes reported. A single fracture occurs in most cases and multiple root fracture is a rare finding. This case report presents a clinical technique of reattachment of coronal fragment of maxillary lateral incisor after trauma using direct fiber-reinforced post systems and simultaneously management of the fracture in the middle third of the root using fibre post as a intraradicular splint. Healing was observed at 1 year follow-up examination.

Management of horizontal root fracture: two case reports

Traumatic dental injuries often occur to the teeth and their supporting tissues and they are the main reasons for emergency visit to a dental clinic. Horizontal root fractures usually are characterized by a fracture line that is perpendicular to the long axis of the root. Root fractures are diagnosed through clinical and radiographic examination. Treatment depends on the position of the fracture, the extent of root involvement, correct diagnosis, clinical management, and radiographic follow-up. This article describes the successful management of intraalveolar horizontal, apical root fracture treated with Mineral trioxide aggregate (MTA) barrier and Ellis class III and middle root fracture treated by using fiber post& core.

Endodontic management of horizontal root fractures in maxillary central incisors

AbstractRoot fracture implies fracture of cementum, dentin, and pulp. These injuries are relatively infrequent as they constitute &lt;3% of all dental injuries. When a root fracture occurs horizontally, the coronal segment may or may not be displaced. This article illustrates two varied treatment options for horizontal root fractures in maxillary central incisors. In the first case, endodontic treatment was performed using a mineral trioxide aggregate (MTA)-based sealer. In the second case, repositioning and splinting of the teeth allowed revascularization and preservation of teeth vitality. A 12-month follow-up period was reported for the two cases.

Horizontal root fracture: a case report

Horizontal root fracture: a case report

Endodontic and prosthetic management of a mid-root and crown fracture of a maxillary central incisor

Root fractures are relatively uncommon among other dental traumas and mostly affect the anterior dentition. This case report presents the endodontic and prosthodontic management of a maxillary central incisor with a combined fracture in the middle third of the root and the crown, as well as the 7-year follow up of the case. The healing potential of a horizontal root fracture in the middle third of the root is highlighted when appropriate treatment is applied. MTA used for obturation of the coronal fragment, induced hard tissue formation apically and promoted healing in the area, while the 2mm MTA left as apical barrier at the second stage of re-treatment and obturation with gutta-percha prevented its extrusion. The multidisciplinary approach in the management of such cases ensures a long term survival.

Multidisciplinary approach for the treatment of horizontal root-fractured maxillary anterior teeth.

Dental trauma can lead to a wide range of injuries of which crown and root fractures are examples. Crown-root fractures often need complex treatment planning. This case report describes the use of MTA in the multidisciplinary management of a patient with a horizontally fractured central incisor and luxation in a different central incisor. A 42-year-old female patient presented within 1 h of receiving direct trauma to her maxillary area. Clinical examination revealed that the right and left maxillary central incisors presented mobility and sensitivity to percussion and palpation but no sensitivity to thermal stimulations. Occlusal displacement with extrusion in the left maxillary central incisor and luxation in the right maxillary central incisor was observed. Radiographic examination revealed horizontal root fracture at the apical third of the left maxillary central incisor. Root fracture in the right maxillary incisor was not observed. Endodontic and aesthetic restorative treatments were completed. MTA showed a good long-term outcome when used in root-fractured and luxated teeth. In addition, composite resin restoration provided satisfactory aesthetic results even after 15 months.

Diagnosis of a horizontal root fracture during retreatment of a maxillary canine utilizing an electronic apex locator and monitoring with CBCT: a case report

Introduction: The aim of this case report is todemonstrate the retreatment of a maxillary caninediagnosed with a horizontal root fracture utilizingan electronic apex locator and monitored with conebeam computed tomography. Case Report: A 35year old African American male was referred for rootcanal retreatment of a maxillary right canine prior toprosthetic rehabilitation. Following removal of guttapercha, an apex locator was utilized to determine thelength of the root canal. After a more comprehensivedental history, the patient confirmed a previouslyunreported history of dental trauma at this time,leading to the suspicion of a horizontal root fracture.Clinical microscopy detected a connective tissue in theapical third of the root canal and multiple periapicaland occlusal radiographs enhanced visualizationof a horizontal root fracture. The coronal segmentwas filled with an MTA apical plug and the apicalsegment remained stable. A recall after 1.5 yearswas performed with CBCT, which showed no apicalradiolucency. Discussion: The present case reportreinforces the precept that detailed dental history andcareful observation of radiographs are critical factorsfor obtaining an accurate diagnosis. Fundamentaladjuncts, such as microscopy, apex locators andCBCT imaging, can potentially aid in the diagnosisand the subsequent treatment plan of horizontal rootfracture.KeywordsCone-beam computed tomography; Apex locator Cuspid; Radiography; horizontal root fracture.