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If the fracture is in the apical third of the root, the prognosis is favorable, provided the tooth is immobilized and it is not placed under undue pressure during mastication. The apposing tooth or teeth should be ground down, to minimize incisal-occlusal stress.
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FRACTURE OF ROOT If the fracture is in the apical third of the root, the prognosis is favorable, provided the tooth is immobilized and it is not placed under undue pressure during mastication. The apposing tooth or teeth should be ground down, to minimize incisal-occlusal stress.
Splinting may be done by ligating the fractured tooth to several adjacent teeth by extracoronal ligation. Several different methods can be used: • acid etch technique cementation of plastic orthodontic brackets in composite, wired together with .01 dead-soft stainless steel wire and reinforced with resin • acid-etch technique cementation of bonded resin with ligation using 20-Ib monofilament plastic fishline and • 3) Solid facial bonding of crowns of teeth adjacent to each other
Orthodontic band wire ligation, or acrylic or cast splint cementation. The splint should be removed in 3 to 6 weeks, depending on the status of the alveolar bone surrounding the tooth, tooth mobility, and the overall root length of the tooth. The pulps of such teeth should be checked periodically for vitality, and radiographs should be taken. In most cases, the pulp remains vital.
When a fracture occurs in the middle or coronal third of the root, the prognosis is less favorable because of the difficulty of immobilizing the tooth. Repair does not occur because of the constant movement of the tooth, as well as exposure of the pulp to the oral environment. In time, the tooth becomes loose and must be removed, or it may even be completely exfoliated as resorption occurs.
A tooth whose root is fractured in its apical third has an excellent prognosis because the pulp in the apical fragment usually remains vital, and the tooth may remain firm in its socket. A mobile tooth should be ligated. If the pulp in the coronal fragment remains vital and the tooth is stable, with or without ligation, then no additional treatment will be indicated.
In the event that the pulp in the coronal fragment dies, then endodontic treatment can be done, preferably limited to the coronal fragment. If the tooth fails to recover the apical root fragment can be removed surgically
Andreasen described three types of root repair following treatment of root fracture 1. Calcified tissue 2. Connective tissue 3. Granulomatous tissue
Vertical Fracture: Vertical fracture of posterior teeth is not as amenable to conservative endodontic treatment as horizontal fracture diagnosis is often difficult to establish by radiograph, percussion, or other means. In most cases, the patient complains of sensitivity and may or may not be able to locate the affected tooth. The tooth may react normally to the electric pulp test, or it may become hypersensitive.
In the early stage, when hair line fracture is present and before separation of the fragments is evident, no radiographic changes are visible either in the tooth or in the adjacent bone. At times, Having the patient chew on a cotton applicator or rubber polishing wheel helps in identifying the tooth.
The prognosis of a tooth with a longitudinal (vertical) fracture depends on the location of the fracture. If the fracture passes through the clinical crown of a multirooted tooth and through its furcation, the prognosis may be favorable, provided the tooth can be hemisected. For example, a buccolingual fracture through the crown of a mandibular molar,
Extending into the bifurcation, can be treated. By endodontic therapy, followed by hemi section and full –coverage restoration of the mesial and distal segments,
Luxated Teeth Luxation is the displacement or dislocation of a tooth from its socket. Luxation may be partial, in which the tooth is partly displaced from its socket, or total, in which the tooth is completely avulsed from its socket.
