ROOT FRACTURES

Root fracture of the tooth is a dentine, cementum fracture involving the pulp. Traumatic tooth fracture occurs most often in middle third of roots of fully erupted teeth. However, RC treated teeth are more susceptible to root fractures as it involves removing the pulp thus weakening the tooth.

VERTICAL ROOT FRACTURE

These are longitudinally oriented fractures which run along the long axis of the tooth. When unrecognised can lead to inappropriate root therapy. Diagnosis is tricky as signs and symptoms are usually delayed and no single feature is indicative of the fracture.

Predisposing factors-

• Roots narrower in mesiodistal dimension are more prone to fractures.
• Dentin of pulpless teeth is stiffer and is at a risk of root fracture.
• Sudden increased biting force on a particular tooth.

Signs and Symptoms-

• discomfort/soreness
• Can be associated with infection
• Mild to severe intensity of pain
• Frequent dislodgment of an apparently well fitting post.

Management

HORIZONTAL ROOT FRACTURE

When the fracture line is perpendicular or oblique to the long axis of the tooth. It can occur in the apical, middle or coronal portion of the root.

Detection-

• Peri apical radiograph
• CBCT (3D view)

Signs and Symptoms-

• Mobility of tooth fragment
• Tenderness on percussion
• Bleeding

Management

Treatment of horizontal fracture involves repositioning, stabilisation and occlusal adjustment.

Apical - 

• Usually no mobility
• Vital tooth
• Wait and watch treatment

Middle-

• Repositioning of the fractured fragment
• Immobilisation via splinting (2-3months)
• If pulp necrosis occurs,

                      - RCT of the segment

                      - Apexification before obturation of this segment

Coronal-

• Poor prognosis
• If the segment is intact, reattachment of the segment
• If the segment is lost, post crowns with subgingival margins
• Fractured part is extracted
• RCT done only of the root length is enough.