Horizontal root fracture: remove or save?
A tooth with a traumatic root fracture was zipped using the Ribbond system. The patient does not show complaints.
What to do? Will we discuss removal and subsequent implantation, or will we talk about a composite bus? Or leave it as it is and watch? How predictable is such a tooth in the long run?
Looking at an x-ray most often such a tooth is removed. However, if we turn to literary sources about the prognosis of horizontal tooth fractures, we can decide to save the tooth.
Andreasen and his team studied a large body of literature that examined the healing of an intra-alveolar root fracture of 534 incisors in patients aged 7 to 17 years. They classified the localization of the root fracture: in the cervical part, in the middle and in the apical third of the root (Fig. 2). In 78% of cases, the fracture healed (mineralized healing, connective tissue or combined), regardless of the location of the fracture at the root.
In 85% of cases, fracture healing occurred without complications during the entire observation period. Over 10 years, the survival rate was 80%. The frequency of tooth extraction with root fractures in the neck of the tooth was 70%. Therefore, if teeth with such fractures are initially removed, the 10-year rate will increase to 88%.
Studying the literature, it can be seen that there is a high probability of preservation of teeth with horizontal fractures in the long term, excluding cases with fractures in the neck of the tooth.
In this clinical situation, a broken central incisor has been functioning for 13 years. This case is more successful (since we have achieved long-term success, despite the fact that the fracture is in the cervical third of the root). We hope that this case will allow us to look at the situation from the other side, and will also help to make a decision in the choice of dental treatment with horizontal root fractures.