Horizontal Root Fracture

IN THE NAME OF GOD

By:Dr. RoohiEndodontics department

description

Etiology

Root fracture - diagnostic signs

Visual signs

The coronal segment may be mobile and in some cases displaced. Transient crown discoloration (red or grey) may occur. Bleeding from the gingival sulcus may be noted.

Root fracture - diagnostic signsPercussion test

Mobility test

Sensibility pulp test

Radiographic findings

Radiographs recommended

Root fracture - diagnostic signs

treatment

Treatment

Localization of fracture line

Treatment

Patient instructions

Follow-up

Healing patterns

Prognosis

No events recorded during 10-year follow-up

Pul necrosisInfection related resorptionAnkylosis resorptionTooth loss

Only pulp canal obliteration was seen

Prognosis

Prognosis

Results, ten years after the injury

Number of diagnosed events Estimated risk (%) 95% confidence

interval

Tooth loss 1 9.1 [ 0 - 24.7 ]

Pulp necrosis 3 23.1 [ 1.6 - 44.5 ]

Pulp canal obliteration 9 > 76.9 not available

Ankylosis 0 0 not available

Inflammatory root resorption 0 0 not available

Surface resorption 0 0 not available

Bone loss 0 0 not available

Prognosis

Results, ten years after the injury

Number of diagnosed events Estimated risk (%) 95% confidence interval

Tooth loss 4 11 [ 0.8 - 21.2 ]

Pulp necrosis 14 33.2 [ 18.4 - 48 ]

Pulp canal obliteration 25 > 67.4 not available

Ankylosis 1 2.5 [ 0 - 7.4 ]

Inflammatory root resorption 0 0 not available

Surface resorption 0 0 not available

Bone loss 2 6 [ 0 - 14.3 ]

Prognosis

Results, ten years after the injury

Number of diagnosed events Estimated risk (%) 95% confidence

interval

Tooth loss 5 54 [ 27.2 - 80.8 ]

Pulp necrosis 5 > 31.2 not available

Pulp canal obliteration 9 > 68.8 not available

Ankylosis 0 0 not available

Inflammatory root resorption 0 0 not available

Surface resorption 0 0 not available

Bone loss 3 18.8 [ 0 - 37.9 ]

Prognosis

Results, ten years after the injury

Number of diagnosed events Estimated risk (%) 95% confidence

interval

Tooth loss 10 21.5 [ 6.4 - 36.6 ]

Pulp necrosis 22 30.9 [ 19.9 - 41.9 ]

Pulp canal obliteration 43 > 69.8 not available

Ankylosis 1 1.5 [ 0 - 4.3 ]

Inflammatory root resorption 0 0 not available

Surface resorption 0 0 not available

Bone loss 5 7.6 [ 1.1 - 14.2 ]

References

• Andreasen FM, Andreasen JO, Bayer T. Prognosis of root fractured permanent incisors – prediction of healing modalities. Endod Dent Traumatol 1989; 5: 11–22. • Andreasen FM, Andreasen JO. Resorption and mineralization processes following root fracture of permanent incisors. Endod Dent Traumatol 1988; 4: 202–214. • Andreasen JO, Andreasen FM, Mejàre I, Cvek M. Healing of 400 intra-alveolar root fractures. 1. Effect pre-injury and injury factors such as sex, age, stage of root development, fracture type, location of fracture and severity of disclocation. Dent Traumatol 2004; 20: 192-202. • Andreasen JO, Andreasen FM, Mèjare I, Cvek M. Healing of 400 intra-alveolar root fractures. 2. Effect of treatment factors such as treatment delay, repositioning, splinting type and period antibiotics. Dent Traumatol 2004; 20: 203-211. •Cvek M, Tsilingaridis G, Andreasen JO. Survival of 534 incisors after intra-alveolar root fracture in patients aged 7-17 years. Dent Traumatol 2008; 24: 379-87. •Andreasen JO, Hjørting-Hansen E. Intraalveolar root fractures: radiographic and histologic study of 50 cases. J Oral Surg 1967, 25, 414-426. •Cvek M. Treament of non-vital permanent incisors with calcium hydroxide. IV. Periodontal healing and closure of the root canal in the coronal fragment of teeth with intra-alveolar fracture and vital apical fragment. A follow-up. Odontol Revy 1974; 25: 239–246. •Cvek M, Andreasen JO, Borum MK. Healing of 208 intraalveolar root fractures in patients aged 7–17 years. Dent Traumatol 2001; 17: 53–62. •Cvek M, Mejàre I, Andreasen JO. Healing and prognosis of teeth with intra-alveolar fractures involving the cervical part of the root. Dent Traumatol 2002; 18: 57–65. •Welbury RR, Kinirons MJ, Day P, Humphreys K, Gregg TA. Outcomes for root-fractured permanent incisors: a retrospective study. Pediatric Dentistry 2002; 24: 98–102. •Jacobsen I, Zachrisson BU. Repair characteristics of root fractures in permanent anterior teeth. Scand J Dent Res 1975; 83: 355–364. •Zachrisson BU, Jacobsen I. Long-term prognosis of 66 permanent anterior teeth with root fracture. Scand J Dent Res 1975; 83: 345–354. •Jacobsen I. Root fractures in permanent anterior teeth with incomplete root formation. Scand J Dent Res 1976; 84: 210–217. •Tsukiboshi M. Optimal use of photography, radiography and micro computed tomography scanning in the management of traumatized teeth. Endod Topics 2006; 14: 4-19. •Wölner-Hanssen AB, von Arx T. Permanent teeth with horizontal root fractures after dental trauma. A retrospective study. Schweiz Monatsschr Zahnmed. 2010;120(3):200-12. •Kirzioglu Z, Koseler Sentut T, Karayilmaz H, Ozay Erturk S. Case series: a clinical study of 27 cases of dentoalveolar root fractures in children and adolescents. Eur Arch Paediatr Dent. 2008 Jun;9(2):98-101. •Diangelis AJ, Andreasen JO, Ebeleseder KA, Kenny DJ, Trope M, Sigurdsson A, Andersson L, Bourguignon C, Flores MT, Hicks ML, Lenzi AR, Malmgren B, Moule AJ, Pohl Y, Tsukiboshi M.

International Association of Dental Traumatology guidelines for the management of traumatic dental injuries: 1. Fractures and luxations of permanent teeth. Dent Traumatol 2012; 28: 66-71.Erratum in Dent Traumatol. 2012;28: 499. •Moorrees CF, Fanning EA, Hunt EE. Age variation of formation stages for ten permanent teeth. J Dent Res 1963; 42: 1490-1502. •Andreasen JO, Andreasen FM, Bakland LK, Flores MT. Root fracture. Traumatic Dental Injuries. A Manual. Oxford: Blackwell/Munksgaard Publishing Company. 2003, 34-35. •Andreasen FM, Andreasen JO, Cvek M. Root fractures. In: Andreasen JO, Andreasen FM, Andersson L, (eds.). Textbook and Color Atlas of Traumatic Injuries to the Teeth (4 th ed.).Oxford, Blackwell 2007. 337-371 • Andreasen JO, Ahrensburg SS, Tsilingaridis G. Root fractures: the influence of type of healing and location of fracture on tooth survival rates -an analysis of 492 cases. Dent Traumatol. 2012, 28: 404-409 •Andreasen JO, Ahrensburg SS, Tsilingaridis G. Tooth mobility changes subsequent to root fractures: a longitudinal clinical study of 44 permanent teeth. Dent Traumatol.2012, 28: 410-414 • Hermann NV, Lauridsen E, Ahrensburg SS, Gerds TA, Andreasen JO. Periodontal healing complications following concussion and subluxation injuries in the permanent dentition. A longitudinal cohort study. Dent Traumatol. 2012, 28: 386-393 •DiAngelis AJ, Andreasen JO, Ebeleseder KA, Kenny DJ, Trope M.International Association of Dental Traumatology guidelines for the management of traumatic dental injuries: 1. Fractures and luxations of permanent teeth. Dent Traumatol. 2012, 28:2-12

etiology

Treatment