Root fracture - diagnostic signs

Description A fracture confined to the root of the tooth involving cementum, dentin, and the pulp. Root fractures can be further classified by whether the coronal fragment is displaced (see luxation injuries).
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.
Percussion test The tooth may be tender.
Mobility test The coronal segment may be mobile.
Sensibility pulp test Sensibility testing may give negative results initially, indicating transient or permanent neural damage. Monitoring the status of the pulp is recommended.

The pulp sensibility test is usually negative for root fractures except for teeth with minor displacements. The test is important in assessing risk of healing complications. A positive sensibility test at the initial examination indicates a significantly reduced risk of later pulp necrosis.
Radiographic findings The root fracture line is usually visible. The fracture involves the root of the tooth and is in a horizontal or diagonal plane.
Radiographs recommended Periapical, occlusal and eccentric exposures.

An occlusal exposure is optimal for locating root fractures in the apical and middle third. Bisecting angle exposure or 90o degree angulation exposure is needed to locate the fractures in the cervical third of the root.

Dental Trauma Guide 2010 - produced in cooperation with the Resource Centre for Rare Oral Diseases and Department of Oral and Maxillo-Facial Surgery
at the University Hospital of Copenhagen - Last edited the 07-01-2014.