Trauma - Root fractures

Question 1

Define a root fracture

Answer 1

Dentine cementum fracture involving the pulp

Question 2

What is the prognosis of a root fracture dependent on? (3)

Answer 2

1. Position of fracture
   - Apical middle coronal 3rd
2. Displacement of fragments
   - Displaced/undisplaced
3. Stage of root development (age of pt)
   - Mature (closed apex)
   - Immature (open apex)
4. Time between injury + tx
5. Presence of infection
6. Associated injuries

Question 3

What fractures have the best prognosis?

Answer 3

Apical 3rd - esp if no displacement

If it heals well the fracture line may be undetectable in future radiographs

Question 4

What fractures have the poorest prognosis?

Answer 4

Coronal 3rd

Very little PDL support to keep the crown in position during function

Creation of an extremely unfavourable crown:root ratio

Question 5

Root fractures clinical exam

Answer 5

Trauma stamp
SI- Sensibility tests (2)

Question 6

What radiographs would you take to assess for a root fracture?

Answer 6

• 1 parallel PA
• 2 additional radiographs taken with different vertical and/or horizontal angulations
• Occlusal radiograph
  Root fractures may be undetected without additional imaging
• CBCT if insufficient info

Question 7

Tx of a root fracture (apical/middle 3rd if displaced)

Answer 7

• Clean area with water/saline/chx
• Reposition with digital pressure
• Flexible splint for 4wks
• Soft diet 1wk and good OH

Review after

4 wk S+
after 6-8 wk
after 4 mo S++
after 6 mo
after 1 y
then yearly for at least 5 y

Question 8

Tx for coronal 3rd fracture

Answer 8

Flexible splint for 4mths

Question 9

Healing outcomes following root fracture

Answer 9

-Calcified tissue union across fracture line
- Connective tissue healing
- Bone healing

Question 10

Non healing outcomes following root fracture

Answer 10

• Granulation tissue (usually associated with loss of vitality)
• Radiolucent area seen on radiograph surrounding fracture line

Question 11

Radiographic features of connective tissue healing

Answer 11

Fracture lines remain visible
Edges of fracture show signs of eburnation

Question 12

Radiographic features of osseous healing

Answer 12

• Separate parts of root become discrete entities with no connection
• Each part has its own distinct PDL space and bone is clearly seen between the fragments

Question 13

% of pulp necrosis for root fractures

Answer 13

20%

Question 14

Tx for non vital apical/middle 3rd root fractures

Answer 14

• Extirpate to fracture line
• Dress nsCAOH then MTA just coronal to fracture line
• GP root fill to fracture line

Apical fragment of root remains in situ with own PDL and can resorb
If infected - antibiotics/apicectomy

Question 15

Gold standard splinting material

Answer 15

Composite + wire

Question 16

Explain steps to splinting

Answer 16

• Cut and bend 0.3mm SS wire
• Apply composite resin to traumatised tooth and those adjacent
• Sink the contoured, passive wire into the composite
• Shape and cure composite
• Smooth rough composite and wire ends