Horizontal Root Fracture Recall.
Fractures, Trauma August 31st, 2006
Yes, I do work on other teeth besides upper anteriors…We’ve just had a few neat recalls this week.
This a case of a horizontal root fracture. The endo was done 1.5 years after the accident because no vitality had returned to the tooth and a grey caste was developing. Endo for prevention of infection was advised. Teeth with horizontal root fractures are tough teeth to endodontically treat and once infection sets in, the prognosis becomes even more guarded.
Once I started the endo, I got through necrotic tissue coronally, but as I approached the fracture line, I found vital tissue (was able to tell because of hyperemia). In order to try to preserve as much of this tissue as possible (to help with potential reduction and stabilization of the fracture and also for possible biologic closure of the end of the coronal root fragment–ie. apexification) I minimally instrumented to the fracture and then filled the canal to that point with white MTA (mineral trioxide aggregate).
Two years later, osseous healing is complete and the root segments appear to be stabilized. Mobility has reduced. There’s a cosmetic issue now though. Although I used white MTA and the pt’s dentist bleached the tooth prior to placing the final resin, it’s turning more and more grey. Oh well, at least he still has the tooth.
And speaking of horizontal root fractures, here is a case that I did years ago. I wouldn’t necessarily do the same thing today but the post op film looks cool.
September 3rd, 2006 at 6:53 am
i had a case that presented with a horizontal root fracture of 11 about a month and a half ago. this poor woman was shoved into an escalator console at a TTC station, no none even stopped to help her. she came straight to the office in extreme pain, obviously, and radiograph revealed a fracture in the apical 1/3 (pretty high up actually), about 1/2 degree mobility. i called the specialist i usually refer to beause this was the first time i had ever seen a patient like this and i wanted some advice. tooth was hypersensitve to endo ice, as can be expected after trauma like that. we basically told her to favor the tooth and return in two weeks for re-eval, at which point the tooth had normal vitality testing, and we’ll wait and see if the root heals itself. she’s coming back in another month or so for re-testing again and i told her to watch for discoloration, etc, and which point i will refer her to the endodontist to complete treatment.
that’s so funny you posted this case, i was just talking about her the other day!
September 3rd, 2006 at 7:40 am
The prognosis is good for her tooth because of the apical location of the fracture and the fact that the tooth is still vital (and didn’t need repositioning).
The tooth that I blogged about needed to be repositioned from a palatoversion after the accident.