Intra-alveolar Root Fractures Research Articles

Use of splinting in traumatized primary teeth: A systematic review of case reports

The aim of this study was to explore the use of splinting in the management of traumatized primary dentition in case reports published in the literature. Systematic searches were performed in the main health databases to identify case reports (a) with children presenting trauma in primary teeth, and (b) those that described any outcomes related to the use of splints in the management of traumatized primary teeth. The stages of study selection, data extraction and risk of bias analysis were performed. Descriptive data analysis was described. The reporting of information from this review was based on the PRISMA 2020 guidelines. Of the total number of studies initially found (n=246), eight were case reports. Outcomes of splint immobilization in primary teeth with luxation (intrusion, extrusion, and lateral displacement), intra-alveolar root fracture and/or alveolar fracture were reported. All case reports described splinting as a viable technique for immobilizing traumatized primary teeth, regardless of the type of traumatic dental injury (TDIs) and splinting technique used. Only case report verified the effectiveness of the splinting in the management of dentoalveolar trauma and demonstrated the clinical effectiveness of the contentive approach. Based on low evidence studies with a moderate risk of bias, it was observed that the use of splints for the management of alveolar bone fractures and intrusive root fractures, and in specific cases of teeth with lateral luxation, can bring additional benefits to the dento-alveolar health of traumatized primary teeth.

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

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

Effect of splinting times on the healing of intra-alveolar root fractures in 512 permanent teeth in humans: A Scandinavian multicenter study.

Long-term splinting of teeth with intra-alveolar root fractures has been considered important for the deposition of hard tissue between the root fragments. The aim of this study was to compare the healing outcomes in teeth with intra-alveolar root fractures relative to splinting times in three dental centers in Scandinavia, using historical data. A total of 512 maxillary and mandibular incisors from three dental trauma centers were included in the study. Two of the centers used long-term splinting protocols of two to three months while the other center used a short-term splinting protocol of one month or less. Three outcomes were evaluated: (1) Healing with hard tissue (dentin and/or cementum). (2) Healing with connective tissue (periodontal ligament) interposition with or without bone between the fragments. (3) Non-healing due to the coronal pulp being necrotic and infected with granulation tissue interposed between the fragments. The mean splinting times were 18, 81, and 110days in the three centers. Long-term splinting resulted in hard tissue healing more frequently than short-term splinting. Short-term splinting resulted in more connective tissue/bony healing than long-term splinting, while there was no difference in the frequency of non-healing between long-term and short-term splinting protocols. While the results suggest that long-term splinting favors hard tissue deposition, one cannot, however, conclude that long-term splinting definitely favors hard tissue healing since the treatment protocols were not randomized among the three centers. More clinical studies on the role of splinting time need to be done.

A Rare Complication in an Untreated Horizontal Root Fracture Case

Intra-alveolar root fractures in permanent teeth are rare following dental traumatic injuries. The diagnosis of root fractures depends on careful clinical and radiographic examination. The successful treatment of a root-fractured tooth involves repositioning and fixation. Although the outcome of a root fracture is generally favourable, complications such as pulpal necrosis, radicular resorption and pulpal canal obliteration can arise. A radicular cyst is an inflammatory cyst that develops as a result of untreated dental caries, with pulp necrosis and periapical infection following chemical, physical or bacterial injury. In this case report, the diagnosis and treatment of a rare case of a radicular cyst, which occurred as a result of pulp necrosis following horizontal root fracture, and an apical root fragment, which was displaced by the cystic lesion to the base of the nasal cavity, are presented.

Surgical management of intra-alveolar root fracture in maxillary premolar - a case report

Intra alveolar radicular fractures in permanent teeth are very rare Horizontal root fractures are commonly observed in the maxillary anterior region of young male patients while in premolars they are very rare These may vary in severity from enamel fractures to avulsions Fracture occurs often in the middle third of the root followed by apical and coronal third In present case incomplete horizontal root fracture located at the junction of apical and middle third of a right maxillary first premolar which was treated endodontically with surgical removal of fractured apical segment After months follow up the tooth was asymptomatic with normal periodontal health

Healing after experimental luxation and intraalveolar root fracture in immature rat teeth

AimsThe purpose of this study was to clarify the histopathological reactions, growth and complications on immature rat molar with intraalveolar root fracture over 3–4weeks. MethodsThe upper first molars of 4-week old male Crlj:WI rats weighing 93.5–107.0 g were pushed horizontally toward the palate to cause a constant amount of dislocation by our previously developed experimental luxation model. The molars were then scanned using two types of 3-dimensional (3D) X-ray micro-computed tomography (μCT), and a 3D analysis was performed. Decalcified sections were also prepared and observed. ResultsIn experimental group, root fracture occurred in four mesial roots out of eight teeth, and reparative dentin and cementum formed on the root fracture line over 3–4 weeks. On the periodontal side of the fracture, the surface of the dentin was covered with cementum, and partially covered with a large amount of cellular cementum. No distinct differences in root length were identified between the control group and the experimental group. All molars in the experimental group defined external root resorption. On the palatal area (cervical compression side), the depth and range of cervical external root resorption lacunae increased to 4 weeks. In experimental group, the width of periodontium tended to be larger than that in the control group, mesial tooth sockets had many blood vessels.

Healing of Horizontal Intra-alveolar Root Fractures after Endodontic Treatment with Mineral Trioxide Aggregate

IntroductionThe purpose of this retrospective study was to evaluate the healing type and assess the outcome of horizontal intra-alveolar root fractures after endodontic treatment with mineral trioxide aggregate (MTA) as filling material. MethodsThe clinical database of the Department of Conservative Dentistry at Yonsei University Dental Hospital, Seoul, Korea, was searched for patients with histories of intra-alveolar root fractures and endodontic treatments with MTA between October 2005 and September 2014. Radiographic healing at the fracture line was evaluated independently by 2 examiners and was classified into 4 types according to Andreasen and Hjørting-Hansen. ResultsOf the 22 root-fractured teeth that received endodontic treatment with MTA, 19 cases participated in the follow-up after a period of at least 3 months. Seventeen of the 19 teeth (89.5%) exhibited healing of the root fractures. For each healing type, 7 teeth (36.8%) showed healing with calcified tissue, 8 teeth (42.1%) showed interposition of connective tissue, 2 teeth (10.5%) showed interposition of connective tissue and bone, and 2 teeth (10.5%) showed interposition of granulation tissue without healing. ConclusionsWithin the limitations of this study, intra-alveolar root fractures showed satisfactory healing outcomes after endodontic treatment with MTA. MTA could be considered to be suitable filling material for the endodontic treatment of horizontal intra-alveolar root fractures.

Repair processes of experimental root fractures in rat molars examined by histopathological techniques and 3D micro-CT imaging

AimsThe purpose of this study was to investigate the repair processes of experimental intra-alveolar root fractures of immature rat molars with histopathological techniques and 3-dimensional micro-computed X-ray tomography (3D micro-CT) imaging. MethodsTwelve left upper first molars of 4-week-old rats were dislocated toward the palate with modified Hoe's pliers at a load of 900 g for 20 s, and repositioned. After 1 or 2 weeks, the maxillae were dissected and scanned with micro CT for 3D micro-CT imaging. After standard histological preparation, buccolingual serial sections of the maxillae were stained with hematoxylin and eosin or Masson–Goldner stain and observed by light microscopy. Subsequently, we examined the identified root fracture lesions by 3D micro-CT imaging and histopathological sections. ResultsWe identified 6 intra-alveolar vertical incomplete fracture lines in the mesial roots. Histopathological findings showed that newly differentiated odontoblast-like cells had formed immature reparative dentin on the pulpal side of the fracture line at 1 postoperative week, and deposited reparative dentin with a tubular structure at 2 weeks. While surface resorption and granulation-tissue formation occurred on the periodontal side of the fracture line, the narrow fracture line remained unchanged, and the surface resorption lacunae were partly covered with cementum at postoperative 2 weeks. ConclusionsRoot-fracture investigation requires a combination of histopathological observation and 3D-CT imaging. Intra-alveolar fractured root repair accompanied by tubular reparative dentin formation at the pulpal side, and the deposition of cementum at the periodontal side, may occur when the fracture line is too narrow for the formation of granulation tissue.

레진 강선 고정을 이용한 유전치 치근 파절의 보존적 치료 : 증례 보고

유치 치근 파절의 치료는 정기 검진을 통해 관찰하거나 발치를 권유하고 있다. 특히 심한 동요도와 변위가 있는 경우 영구치 손상 가능성과 흡인의 위험성 때문에 주로 발치를 시행한다. 하지만 최근 재위치와 고정을 통한 보존적 치료가 새롭게 제시되고 있다. 이른 시기의 유전치 발치는 심미적 문제, 발음 저작 등의 기능적 문제, 공간 소실, 환아와 보호자의 심리 사회적인 문제 등 여러 가지 문제점들을 야기하므로 치근 파절된 유치를 유지하는 것만큼 좋은 치료는 없다. 이 증례 보고는 치근 파절을 보이는 두 증례의 진단, 치료, 평균 27개월의 정기 검진 자료를 토대로 심한 동요도와 변위가 있는 유치 치근 파절의 보존적인 치료 가능성을 제시하고자 하였다. 두 증례에서 발치 대신 재위치와 장기간의 레진 강선 고정을 시행하였고, 후속 영구치가 맹출 할 때까지 정기검진을 시행하였다. 정기검진과정 중에 동통, 치수괴사, 감염, 영구치 치배 변위, 맹출 이상 등의 부작용은 나타나지 않았다. In an intra-alveolar root fracture (IARF) of a primary tooth with severe mobility and displacement, extraction and periodic-follow-up is the choice of recommended treatments because of the fear of aspiration of the mobile tooth and the possibility of damage in the permanent succeeding tooth. However, repositioning and splinting are presented as a fresh proposal recently. In case of extracting a primary incisor, many problems occur; esthetic problems; functional problems such as pronunciation and mastication; space loss; and psychological and social problems. Therefore, the best treatment is conservation of the primary tooth. The aim of this report was to suggest the conservative treatment of an Intra-alveolar root fracture of the primary central incisors with severe mobility and displacement based on two cases that describe the diagnoses, treatments and follow-ups (mean period: 27-month). All cases have been treated by reduction and immobilization by resin wire splint (RWS) (mean period: 6-week). Both cases were followed up until the successors were erupted. There have been no complications such as pain, pulp necrosis, periapical lesion, displacement of permanent tooth germ, eruption disturbance and etc.

Healing responses following transverse root fracture: a historical review and case reports showing healing with (a) calcified tissue and (b) dense fibrous connective tissue

The understanding and management of transverse intra-alveolar root fractures has evolved to its current high level of sophistication and clinical success from foundations laid down by histological studies as early as the mid-nineteenth century. The aim of the review was to highlight those earlier histological reports and studies that have contributed to the current understanding of the biological processes involved in the healing of transverse root fractures. Healing of a transverse root fracture by calcified tissue was demonstrated histologically by Howe in 1926, while Boulger in 1928 showed the two other patterns of root fracture healing, namely the interposition of fibrous connective tissue and the interposition of bone and periodontal ligament around both fractured segments. Other major histological reports around that time came from members of the so-called 'The Vienna group of Illinois', who had a significant influence in the development of oral biology worldwide. Other important reports and an experimental study emanated from Germany and Switzerland in the late 30s and early 40s, followed in the 1950s and early 1960s by histological material principally from Sweden, Denmark, France, the USA and Britain. Jens Andreasen and Erik Hjörting-Hansen's landmark paper in 1967 included new histological reports and a classification of healing responses following transverse root fractures. The expansion of knowledge related to root fractures since that time has been exponential, with major contributions from Scandinavia and several other countries. Accompanying the historical review are two case reports with histology of root fracture healing by (a) calcified tissue and (b) dense fibrous connective tissue. The role of the pulp and the periodontal ligament in the repair process is described and the clinical significance discussed with particular emphasis to diagnosis and orthodontic management.

Horizontal root fracture accompanied by luxation of coronal fragment in a maxillary central incisor: a case report.

Root fracture injuries affect up to 7% of permanent teeth. This type of injury is rarely seen in teeth with open apices and depending on the fracture site, the prognosis is good. This case report describes a horizontal intra-alveolar root fracture in the middle third of a maxillary central incisor associated with an extrusive luxation of the coronal segment and its treatment in a 6-year-old girl. The patient was observed under a regular follow-up regime. After 2 years, clinical examination showed normal tooth color and position, with a positive response to the pulp test.

Acute treatment of a concomitant horizontal root fracture and luxation of the coronal fragment of the right upper central incisor: a case report

We report a case of a horizontal intra-alveolar root fracture between the middle and apical third of the upper right central incisor associated with an extrusive luxation of the coronal fragment, in a 24-year-old male patient. Twenty minutes after being accidentally hit by a metallic device, the patient's coronal portion was repositioned and splinted under local anesthesia. After that, we lost sight of the patient. One year later, the patient showed up. The splint was lost, the tooth showed physiological mobility and responded to pulp testing. Radiographs showed healing of the horizontal fracture and normal periodontal ligament.

Horizontal root fracture followed for 6 years

Intra-alveolar root fractures in permanent teeth are uncommon injuries among dental traumas. Generally, the principles of treating horizontal root fractures of permanent teeth are repositioning and fixation. The present paper reports 6-years follow up of two horizontally root-fractured teeth that were healed with calcified tissue. Both of the teeth were clinically and radiographically symptomless and showed complete pulp canal obliterations.

Orthodontic movement of a horizontally fractured tooth: a case report

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.

Healing of 400 intra-alveolar root fractures. 2. Effect of treatment factors such as treatment delay, repositioning, splinting type and period and antibiotics

Healing of 400 intra-alveolar root fractures. 2. Effect of treatment factors such as treatment delay, repositioning, splinting type and period and antibiotics

Healing of 400 intra-alveolar root fractures.1. Effect of pre-injury and injury factors such as sex, age, stage of root development, fracture type, location of fracture and severity of dislocation

Healing of 400 intra-alveolar root fractures.1. Effect of pre-injury and injury factors such as sex, age, stage of root development, fracture type, location of fracture and severity of dislocation

Unusual horizontal and vertical root fractures of maxillary molars: An 11-year follow-up

Intra-alveolar root fractures of posterior teeth are rare when compared with other dental injuries. This case report describes one vertical and two horizontal root fractures of teeth 3, 14, and 15. The teeth all tested normal to cold and electric pulp tests. The patient reported no history of accidental trauma, and no signs of scarring were found. These fractures were discovered during a routine full-mouth radiographic survey. All teeth were asymptomatic and in good function. During the 11 yr that followed, there was no dental treatment, except for routine periodontal maintenance. The patient had one abscess that occurred after 9 yr on tooth 3, which had to be extracted. The upper left molars are surprisingly still in function and asymptomatic. Either occlusal or lateral trauma may be the cause of these fractures. This would strongly suggest night guard appliances for patients who clench or grind. A psychological evaluation of the patient might reveal neurosis, anxiety, or stress situations affecting teeth.

Replantation for the treatment of transverse intra-alveolar root fracture

This case report examines the effectiveness of extraoral treatment of a traumatized maxillary central incisor with a transverse intra-alveolar root fracture. Both the coronal and root segments were extracted after anesthetic injection. After treatment of the pulpal cavity, the segments were synthesized with a composite resin and a canal reamer. The extracted tooth was replanted into the original socket. This method is an alternative treatment for transverse intra-alveolar root fracture, which is presently an indication for dental extraction in almost all cases.

Endodontic therapy of traumatized incisors with crown and transverse intra-alveolar root fractures

A case involving traumatic injury to the maxillary anterior teeth with crown and transverse intra-alveolar root fractures is reported. The patient did not seek immediate treatment after trauma. Treatment included pulpectomy, fixation of a fractured root, root canal obturation, endodontic therapy of the coronal segment, and postoperative observation. Follow-up showed good results. Thus effective nonsurgical endodontic therapy of traumatized anterior teeth can result in a good prognosis in cases involving crown and intra-alveolar root fractures.

Clinical Considerations in the Diagnosis and Treatment of Intra-Alveolar Root Fractures

Clinical and radiographic data collected from the 14 cases of intra-alveolar root-fractures, with follow-ups of one to 25 years, complement the findings of other investigators in that the prognosis of the endodontium is extremely favorable. A survey of reports indicate that 75% to 80% of the pulps in intra-alveolar root fractures recover with no need of any endodontic therapy. Furthermore, pulpal pain is seldom encountered. Although the electric pulp tester is considered an important diagnostic tool, it does have limitations. The significance of the negative response is questionable, especially in young, undeveloped teeth with open apexes. The failure to respond to the tester may be attributed to a high electrical impedance. As nociceptor nerve fibers are last to develop, failure to respond to the tester in young teeth may give a false signal of pulp necrosis. Traumatized vital teeth often give an initial negative response, as does a tooth with rapid dentin deposition. Fracture detection can be increased by taking X rays from more than one angle. Radiolucent areas occur in the region of the root fracture more readily than in the periapical region, in a ratio of 7 to 1. Variations in angulations can give false impressions of complete dentinal union and complete or incomplete calcification of the pulpal space and an illusion of a comminuted fracture. The latter seldom occur in intra-alveolar root fractures. Furthermore, the apparent obliteration of the canal and pulp chamber, as seen on the radiograph, does not imply total obliteration with calcific tissue. The root canals are most often patent and negotiable.(ABSTRACT TRUNCATED AT 250 WORDS)