Radicular Fractures Research Articles

Factors Influencing Vertical Radicular Fractures in Teeth Supported by Metallic Dental Core: A Scoping Review.

The aim of this work is to conduct a literature review to highlight all the parameters involved in sub-prosthetic radicular fractures of teeth supported by metallic dental core. The following research was performed among published studies over the last 10 years in two PubMed/Medline and Scopus and supplemented by manual searching within the bibliographies. The search was restricted to publications in English and French. Out of the 1464 articles initially identified, 18 studies met our inclusion criteria and were subsequently included in the literature review. These consisted of eight Finite Element Analysis Studies, two Retrospective Studies and one Randomized Controlled Trial. The results of this review show that radicular fractures are influenced by several variables, including predisposition, with maxillary premolars and mandibular molars being the most commonly affected teeth. Intracanal preparation can induce crack formation, leading to localized high stress concentrations. Increased ferrule height to 2 mm significantly enhances dental fracture resistance. Using high modulus of elasticity alloys results in nearly complete stress transmission to dentin due to their limited deformability and absorption capacity. The highest fracture resistance is achieved when posts are sealed using resin-modified glass-ionomer cement. Longer posts may be preferable to prevent vertical fractures. Additionally, occlusal factors, through repetitive stresses, contribute to crack propagation from surface defects, a phenomenon termed fatigue fracture. These findings have significant implications. Practitioners should be aware of the predisposition of certain teeth, the importance of preserving the ferrule effect, the choice of root post materials, post Cement Material and the role of occlusal forces in managing and preventing vertical root fractures.

Third Molar Surgery: Risk Factors and Complications after Removal of Third Molars

Objective: There is a need for this research because it aims to identify characteristics that increase the likelihood of negative outcomes following the removal of third molars. Study Design: Observational/transversal study Place and Duration: Dental College HITEC-IMS Taxilla/ Gulraiz Dental Clinic Quaid Avenue Main Road, Gulraiz 3, Rawalpindi. Nov 2020-June 2021 Methods: A total of 180 male and female participants were included in this study. The patients ranged in age from 20 to 50. Pericoronitis and tooth impaction were among the complaints of the patients included in the study. The oral and maxillofacial department operated on all of the patients who requested the removal of their third molars. All patients provided written consent before having their personal data collected, including their age, gender, BMI, kind of impaction, and location of their third molar. Various operative variables were employed. In our research, we looked at post-operative complications and risk variables. The whole data was analyzed with SPSS 23.0. Results: 110 (61.1%) patients were males and 70 (38.9%) cases were females. 28.17±9.47 years were the mean age with mean BMI 24.11±3.65 kg/m2. Most of the teeth impacted in left side found in 102 (56.7%) patients. Most common type of impaction was mesioangular among 90 (50%) cases followed by distoangular 45 (23.7%) cases. Majority of the third molars were fully impacted 120 (66.7%), 38 (21.1%) were partially impacted and frequency of erupted tooth was 22 (12.2%). All the third molars were removed by buccal guttering technique under local anesthesia. Post-operative infection was the most common complication found in 80 (44.4%) cases followed by gingival defect in 27 (15%) radicular fractures in 24 (13.3%) cases. Location of the third molar and bone removal was the most common factor found. Conclusion: There was an increased risk of problems with tooth sectioning, bone removal, and/or tooth localization in patients above the age of 22. Both the evaluation of the indications for the removal of third molars and the process of informed consent should reflect this information. Keywords: Third Molars, Surgery, Anesthesia, Complications, Impactions

Influence of CBCT metal artifact reduction on vertical radicular fracture detection.

PurposeThis study evaluated the influence of a metal artifact reduction (MAR) tool in a cone-beam computed tomography (CBCT) device on the diagnosis of vertical root fractures (VRFs) in teeth with different root filling materials.Materials and MethodsForty-five extracted human premolars were classified into three subgroups; 1) no filling; 2) gutta-percha; and 3) metallic post. CBCT images were acquired using an Orthopantomograph 300 unit with and without a MAR tool. Subsequently, the same teeth were fractured, and new CBCT scans were obtained with and without MAR. Two oral radiologists evaluated the images regarding the presence or absence of VRF. Receiver operating characteristic (ROC) curves and diagnostic tests were performed.ResultsThe overall area under the curve values were 0.695 for CBCT with MAR and 0.789 for CBCT without MAR. The MAR tool negatively influenced the overall diagnosis of VRFs in all tested subgroups, with lower accuracy (0.45–0.72), sensitivity (0.6–0.67), and specificity (0.23–0.8) than were found for the images without MAR. In the latter group, the accuracy, sensitivity, and specificity values were 0.68–0.77, 0.67–083, and 0.53–087, respectively. However, no significant difference was found between images with and without MAR for the no filling and gutta-percha subgroups (P>0.05). In the metallic post subgroup, CBCT showed a significant difference according to MAR use (P<0.05).ConclusionThe OP 300 MAR tool negatively influenced the detection of VRFs in teeth with no root canal filling, gutta-percha, or metallic posts. Teeth with metallic posts suffered the most from the negative impact of MAR.

Clinical Case Employing Two Different Biomaterials in Bone Regeneration

The case of a 59-year-old woman lacking bone in the lower left side of her mandible, and treated with two different biomaterials for bone regeneration, is reported here. Specifically, two different anatomical sites damaged by two different pathologies were studied: a radicular fracture and peri-implantitis. The sites were treated via xenograft bone substitute and calcium phosphosilicate, respectively. Follow-up evaluations showed that the two different methodologies employing different materials in the same organism undergoing the same metabolic processes achieved the same good results. This represents a significant change in current surgical strategies for the dental region: instead of focusing on a single gold-standard technique, it is possible to follow a hybrid approach by adapting the biomaterial and the protocol used to the specificities of the defect.

Immediate Crown Replacement: a case report of extensive radicular fracture with intra-canal anchorage

Aim: Fracture by trauma is one of the most common type of dental injury in the permanent dentition. The purpose of this case report is to present the multidisciplinary management of a subgingival crownroot fracture in one patient. Summary: In this article we report one case of complicated crown-radicular fractures reattachment, in a traumatized maxillary permanent central incisor, which was treated with a novel method preserving coronal integrity after fiber post placement.

Failure Load of Maxillary Central Incisor Restored with CAD/CAM Endocrown Using Different Designs

Statement of problem: Restoration of a severely destructed non-vital tooth is usually challenging, especially, in case of incomplete circumferential tooth structures. Materials and methods: Sixty intact maxillary central incisors were collected. All teeth were decoronated leaving 2 mm above the CEJ then were divided into two divisions (30 specimens for each) according to the radicular depth (2 mm &4 mm). Each division was divided into three groups (10 specimens for each) according to residual coronal tooth structures (circumferential, only labial and only palatal) to obtain six groups of testing. Then milling was done for (IPS e.max CAD) followed by final cementation. Fracture resistance was tested using a universal testing machine. Results: Specimens restored with endocrowns having 2 mm radicular length, exhibited fracture resistance better than that with 4 mm radicular length, without statistical significant difference. Endocrowns with 2 mm circumferential residual coronal tooth structures in both radicular lengths exhibited fracture resistance better than that having either labial or palatal residual coronal tooth structures with a statistically significant difference. The specimens having 2 mm labial residual coronal tooth structures in each radicular length exhibited fracture resistance better than that with 2 mm palatal residual coronal tooth structures in each radicular length with a statistically significant difference. Conclusion: For restored endodontically treated maxillary central incisor by endocrown: residual 2 mm circumferential wall presented better fracture resistance than that with only residual labial or palatal wall and residual labial wall presented better fracture resistance than the palatal wall.

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

Influence of remaining coronal tooth structure on fracture resistance and failure mode of restored endodontically treated maxillary incisors

Statement of problemLimited information is available on the effect of an incomplete ferrule because of the varying residual axial wall heights and the volume of residual tooth structure on the fracture resistance of endodontically treated and restored maxillary incisors. PurposeThe purpose of this in vitro investigation was to examine the effect of varying residual axial wall heights, residual coronal tooth structure, and the absence of 1 proximal axial wall on the fracture resistance and failure mode of endodontically treated teeth restored with metal posts. Material and methodsSixty intact human maxillary central incisors were divided into 6 groups (n=10): no ferrule (NF), 2-mm complete ferrule (CF2), 2-mm (IF2), 3-mm (IF3), and 4-mm (IF4) incomplete ferrules missing a single interproximal wall, and a control group that had a 6-mm incomplete ferrule (IF6). Cast metal post-and-cores were placed in all experimental specimens except for controls. Control specimens received 1 interproximal cavity preparation extending to the root canal access and a composite resin restoration. Complete metal crowns were then cemented on all specimens. Completed specimens were subjected to thermocycling (6000 cycles, 5°C/55°C) followed by the immediate testing of fracture resistance. Failed specimens were sectioned buccolingually and evaluated to identify the failure mode. The data were analyzed with an analysis of variance (ANOVA) and the Student-Newman-Keuls multiple comparison test (α=.05). ResultsAn incomplete ferrule (IF2) with 1 interproximal wall missing had significantly reduced fracture resistance (697 N) compared with a complete ferrule (932 N). An increase of 3 to 4 mm of remaining wall height improved fracture resistance, from 844 N (IF3) to 853 N (IF4). Partial decementation was noticed in 8 NF and 5 IF2 specimens. IF3 and IF4 had no decementations. Radicular fractures and cracks (catastrophic failure) were observed in all IF2, IF3, and IF4, 9 CF2, and 6 NF specimens. In 7 specimens without posts (IF6, control), composite resin foundation and/or coronal dentin fracture were observed and the failure was considered repairable. ConclusionsThe results of this in vitro study indicated that specimens with a 2-mm ferrule of uniform height were more resistant to fracture than specimens with a 2-mm ferrule and 1 missing interproximal wall. An increased wall height of 3 or 4 mm was associated with a significant increase in fracture resistance and can compensate for the missing interproximal wall.

Management of Horizontal Root Fracture in the Middle Third via Intraradicular Splinting Using a Fiber Post.

Radicular fractures in permanent teeth are uncommon injuries and account for only 0.5–7% of dental traumas. These fractures commonly result from a horizontal impact and are transverse to oblique in direction. Their incidence is more in the middle third of the root than at the apical and cervical thirds. This paper describes a case of complicated crown fracture of maxillary incisors along with horizontal root fracture at the middle third of maxillary right central and lateral incisor. The fractured root fragments of the upper right central and lateral incisor were united with the help of a glass fiber post after receiving an endodontic treatment. The other two incisors were treated endodontically followed by post endodontic restorations. Eventually the four incisors were restored with porcelain fused to metal crowns. A one-year follow-up revealed a well stabilized assembly of the root fragments and the post.

Management of Root Fracture: A Novel, Noninvasive Treatment Approach

Traumatic injuries to teeth account for approximately 25% of dental conditions where a patient seeks dentist for emergency treatment. Radicular fractures are one such entity which is very challenging to address due to various complications like periodontal communication, increased mobility, and continued pulpal infection leading to necrosis. Radicular fractures in the middle third have long been considered teeth of salvage due to their unfavourable fracture pattern. During the recent years introduction of biomimetic materials has opened the horizon for saving these teeth. In the present case report a novel approach to the management of radicular fractures in the middle third has been presented.

Conservative management of displaced horizontal root fracture

Traumatic injuries of teeth are the main cause of emergency treatment in dental practice. Radicular fractures in permanent teeth are uncommon, being only 0.5-7% of the cases. Horizontal root fractures are more frequently observed in the maxillary anterior region of young male patients and vary in severity from enamel fractures to avulsions. Fracture occurs often in the middle-third of the root followed by apical and coronal third. The present case report describes a clinical case of a horizontal root fracture located at the middle third of a maxillary left-central incisor treated endodontically after approximating fracture segment with the help of orthodontic appliance. After 6 months follow-up, the tooth was asymptomatic with normal periodontal health.

Factors associated with complications of removal of third molars: a transversal study

The purpose of this study is to estimate the overall frequency of complications associated with third molars (M3) removal and to identify the risk factors associated with these complications. To the transversal analysis, a researcher confidentially reviewed the records of all M3 surgery patients. The predictor variables were demographic (i.e. age and gender), localization and position of third molar, bone removal and tooth sectioning. 210 patients had one or more third molars teeth removed, a total of 605 teeth. The sample's mean age was 21.6±9.2 years, with 1,4 woman to 1 man. Postoperative complications were recorded in 54 extractions of third molars. The most common complications were infection (42.6%), followed by radicular fractures (11.1%) and gingival alterations (11.1%). Complications were significantly affected by 3 factors: age over 25 years old (p=0.002--OR 2.21), location (p=0.006--OR 2.36), bone removal (p=0.002--OR 3.03) and tooth sectioning (p=0.00002--OR 3.59). The results of these analyses suggest that age, location of the tooth, bone removal and tooth sectioning appear to be associated with a higher complication rate for M3 extractions.

Treatment of horizontal root fracture: a case report

Radicular fractures in permanent teeth are uncommon injuries among dental traumas, being only 0.5-7% of the cases. Traumatic dental injuries occur more frequently in young patients, and vary in severity from enamel fractures to avulsions.The magnitude of these problems is confirmed by statistical data on the prevalence of dental trauma during childhood and adolescence.Fracture occurs often in the middle-third of the root and rarely at the apical-third. The present paper reports a clinical case of a horizontal radicular fracture located between the middle- and apical-third of a upper left-central incisors followed-up over 4 years.

Conservative management of horizontal root fracture of a maxillary permanent incisor: case report

A case is presented of an 11-year-old boy who was diagnosed with a horizontal radicular fracture located in the middle third of a maxillary right central incisor that was immediately managed conservatively. Subsequent to the injury, the patient complained of inability to bite, a swollen upper lip and pain on palpation in the periapical region of the tooth. Clinically the tooth appeared extruded. Radiographic examination revealed a root fracture. The extruded tooth was repositioned and immobilised with a wire-composite splint, under a suitable prophylactic antibiotic and anti- inflammatory analgesic coverage for one week. Two years after trauma, the treated tooth was firm and healthy with good aesthetics and normal function.

Infection and microleakage the caused of endodontic failure

The success of endodontic treatment depends on the quality of endodontic treatment and the final restoration. The mean reason for endodontic treatment failure is usually microleakage. That is why it becomes one of the priorities for dental research to prevent microleakage. Infection during the root canal treatment can be prevented. First, by employing strict aseptic clinical techniques follows by cleaning all bacteria and preoperative necrotic pulp-tissue remnants from the root canal. Irrigants are essential in this phase. The shaping of the canal is also an important prerequisite for endodontic success. Removal of the smear layer can enhance seal ability. Second, obturation of the root canal should leave the tooth in the most biological inert condition possible, and it must prevent reinfection as well as the growth of any microorganisms remaining in the canal. The application of an antibacterial dressing between appointments is absolutely necessary or the root canal has to be obturated at the first appointment in order to deprive the microorganisms of nutrients and space to multiply. The temporary filling must be at least 3.5 mm thick. Failure occurs because of missed canals, iatrogenic events and radicular fractures have to be avoided. At the end, clinicians have to confirm that the root canal is cleaned and hermetically obturated because hermetic root canal filling will prevent the leakage of an irritant to the apical area.

Effect of iterative restoration on the detection of artificially induced vertical radicular fractures by Tuned Aperture Computed Tomography.

The purpose of this study was to evaluate the effect of the number of iterative restorations (IR) on the diagnostic accuracy of Tuned Aperture Computed Tomography images (TACT) for detection of induced vertical/oblique root fractures in mandibular teeth. Fractures were induced in 28 single-rooted, endodontically treated cadaver mandibular teeth while another 26 such teeth served as controls. TACT slices reconstructed by using 9 arbitrary projections (angular disparity of 9 degrees -20 degrees) were iteratively restored 1, 2, and 3 times. Eight observers scored their diagnoses by using a confidence rating scale. Ground truth was available from direct examination with transillumination, following extraction. Mean areas under the representative ROC curves for the 3 operations were 0.96 (3 IRs), 0.87 (2 IRs), and 0.86 (1 IRs). Analysis of variance demonstrated significant differences between 3 and 1 to 2 IRs (P <.01), as well as between observers (P <.01). Diagnostic accuracy of TACT for vertical/oblique root fracture detection improved after 3 IRs.

Effect of core stiffness on the in vitro fracture of crowned, endodontically treated teeth

Statement of Problem. Dentin and core materials that substitute for missing dentin are dissimilar materials. A core material with a lower elastic modulus may deform more under applied stress and therefore result in reduced stress concentration at the core/dentin junction. Purpose. This in vitro study examined the effect of core stiffness on the fracture resistance and failure characteristics of a crowned, endodontically treated tooth under simulated occlusal load. Material and Methods. Forty extracted human mandibular premolars were divided equally into 4 groups and prepared for posts and cast crowns as follows: group 1 = cast post and core, cast crown; group 2 = preformed metal post, composite core, and cast crown; group 3 = preformed metal post, amalgam core, and cast crown; and group 4 (control) = preformed metal post, no core, and cast crown. All prepared teeth had 2 mm of sound dentin on which the cemented crown rested. A continuous load (kg) was applied to the buccal cusp at a 30-degree angle to the long axis of each tooth at a crosshead speed of 2 mm/min until failure. Collected data were subjected to 1-way analysis of variance with the Welch modification to compare groups (P<.05). Results. Failure loads for the 4 test groups were as follows: 98.1 ± 34.6 kg (group 1), 94.4 ± 41.8 kg (group 2), 105.5 ± 18.6 kg (group 3), and 101.1 ± 55.3 kg (group 4). No significant difference in failure load values was found among the 4 groups. The primary mode of failure (80%) in all groups was an oblique radicular fracture, either apical to the post or at the post level. Horizontal fracture of the root and post was found in groups 1, 2, and 3 (20%). Loosening of the crown, post, and core was found only in group 2(20%). Conclusion. Within the limitations of this study, core stiffness did not affect the failure resistance of teeth restored with posts and cores and complete-coverage cast metal crowns. The dominant pattern of failure was unrepairable root fracture. Only the composite core exhibited repairable fractures. (J Prosthet Dent 2002;88:302-6.)

The management of an anterior radicular fracture

Trauma involving an upper incisor is an unfortunateoccasional occurrence in childhood. “By the age of seven years, 28% of girls and 32% of boys have suffered a traumatic dental injury to the primary dentition. In the permanent dentition a marked increase is seen for boys aged 8 to 10…” (1). The most common sequelae of this event are avulsion, partial avulsion or subluxation, and coronal or radicular fracture. “Root fractures, defined as fractures involving dentin, cementum and pulp are relatively uncommon among dental trauma, comprising 0.5 to 7 percent of the injuries affecting the permanent dentition…” (2). “In younger individuals with permanent incisors in various stages of eruption and with incomplete root development root fractures are unusual…” (2). Radicular fracture, when it occurs, usually occurs in cases of completely or nearly completely formed roots. In these instances, it is usually a horizontal radicular fracture (3. 4). In cases of incomplete root formation, the consequences of trauma is usually avulsion or subluxation (5). Trauma involving an upper incisor is an unfortunateoccasional occurrence in childhood. “By the age of seven years, 28% of girls and 32% of boys have suffered a traumatic dental injury to the primary dentition. In the permanent dentition a marked increase is seen for boys aged 8 to 10…” (1). The most common sequelae of this event are avulsion, partial avulsion or subluxation, and coronal or radicular fracture. “Root fractures, defined as fractures involving dentin, cementum and pulp are relatively uncommon among dental trauma, comprising 0.5 to 7 percent of the injuries affecting the permanent dentition…” (2). “In younger individuals with permanent incisors in various stages of eruption and with incomplete root development root fractures are unusual…” (2). Radicular fracture, when it occurs, usually occurs in cases of completely or nearly completely formed roots. In these instances, it is usually a horizontal radicular fracture (3. 4). In cases of incomplete root formation, the consequences of trauma is usually avulsion or subluxation (5). El trauma de los incisivos superiores es un hecho infortunado que ocurre en la niñez. Alos 7 años 28% de niñas y 32% de niños han sufrido trumatismos dentales en la dentición primaria. En la dentición permanente un marcado incremento es notado en los niños de 8 a 10 años. La secuela más común de este accidente es la avulsión, avulsión parcial o subluxación, fracturas coronarias o radiculares. Fracturas radiculares definidas como fracturas que involucran a la dentina, cemento o pulpa, son relativamente poco comunes entre traumas dentales, siendo 0.5 a 7% de los daños que afectan la dentición permanente… (2). En individuos más jóvenes, con incisivos permanentes en distintas etapas de erupción y con la raiz incompletamente desarrollada las fracturas radiculares no son usuales. Las fracturas radiculares cuando ocurren, casi siempre lo hacen en casos de raíces completamente o casi completamente desarrolladas. En esta instancia lo mas comun es una fractura radicular horizontal. En casos de raices incompletas la consecuencia del trauma es por lo general avulsión o subluxación. El trauma de los incisivos superiores es un hecho infortunado que ocurre en la niñez. Alos 7 años 28% de niñas y 32% de niños han sufrido trumatismos dentales en la dentición primaria. En la dentición permanente un marcado incremento es notado en los niños de 8 a 10 años. La secuela más común de este accidente es la avulsión, avulsión parcial o subluxación, fracturas coronarias o radiculares. Fracturas radiculares definidas como fracturas que involucran a la dentina, cemento o pulpa, son relativamente poco comunes entre traumas dentales, siendo 0.5 a 7% de los daños que afectan la dentición permanente… (2). En individuos más jóvenes, con incisivos permanentes en distintas etapas de erupción y con la raiz incompletamente desarrollada las fracturas radiculares no son usuales. Las fracturas radiculares cuando ocurren, casi siempre lo hacen en casos de raíces completamente o casi completamente desarrolladas. En esta instancia lo mas comun es una fractura radicular horizontal. En casos de raices incompletas la consecuencia del trauma es por lo general avulsión o subluxación.