IADT treatment guidelines for root fracture

root-fracture4

Clinical findings

  • The coronal segment may be mobile and may be displaced.
  • The tooth may be tender to percussion.
  • Bleeding from the gingival sulcus may be noted.
  • Sensibility testing may give negative results initially, indicating transient or permanent neural damage.
  • Monitoring the status of the pulp is recommended.
  • Transient crown discoloration (red or grey) may occur.

Radiographic findings

  • The fracture involves the root of the tooth and is in a horizontal or oblique plane.
  • Fractures that are in the horizontal plane can usually be detected in the regular periapical 90angle film with the central beam through the tooth. This is usually the case with fractures in the cervical third of the root.
  • If the plane of fracture is more oblique which is common with apical third fractures, an occlusal view or radiographs with varying horizontal angles are more likely to demonstrate the fracture including those located in the middle third.

Treatment

  • Reposition, if displaced, the coronal segment of the tooth as soon as possible.
  • Check position radiographically.
  • Stabilize the tooth with a flexible splint for 4 weeks. If the root fracture is near the cervical area of the tooth, stabilization is beneficial for a longer period of time (up to 4 months).
  • It is advisable to monitor healing for at least 1 year to determine pulpal status.
  • If pulp necrosis develops, root canal treatment of the coronal tooth segment to the fracture line is indicated to preserve the tooth.

Follow-up

  • 4 weeks – Splint removal, clinical and radiographic examination.
  • 6-8 weeks – Clinical and radiographic examination.
  • 4 months – Splint removal in cervical third fractures,  clinical and radiographic examination.
  • 6 months – Clinical and radiographic examination.
  • 1 year – Clinical and radiographic examination.
  • 5 years – Clinical and radiographic examination.