Differences in Healing of a Horizontal Root Fracture as Seen on Conventional Periapical Radiography and Cone-Beam Computed Tomography

Abstract

Different locations and healing patterns of horizontal root fractures bear different prognoses. Conventional periapical radiographs have been routinely used for the evaluation of the locations and healing of horizontal root fractures, with the limitation of presenting two-dimensional images. The three-dimensional imaging technology, cone-beam computed tomography (CBCT), has recently gained interest in dental traumatology, in particular for locating and diagnosing root fractures. However, the assessment of healing patterns of horizontal root fracture using CBCT compared to conventional radiographs has not been established. This case report describes the different healing patterns evaluated by two-dimensional radiographs and CBCT of a horizontally root-fractured maxillary right central incisor treated with mineral trioxide aggregate (MTA) with a two-year follow-up. The findings suggest that the healing patterns of horizontal root fractures seen on conventional radiographs and CBCT may be different.

Management of Oblique Root Fracture Using Mineral Trioxide Aggregate: A Case Report

“…In this case, the sagittal CBCT slice of tooth 11 reveals an oblique root fracture from the middle third on the facial aspect through the cervical third on the palatal aspect, rather than the horizontal fracture that was diagnosed on periapical radiographs. While the final diagnosis just needs periapical radiographs for root fractures in the apical or cervical third, CBCT is recommended for fracture lines in the middle third of root [3,4,12]. Besides, this patient revealed the impacted tuberculate tooth in the maxillary region which needed CBCT to determine either its location or relationship with the affected tooth.…”

“…Traditionally, an apexification procedure of this segment technique involves the repeated placement of calcium hydroxide over a period of time until a calcific barrier is formed at the fracture line before obturation of the root canal. The main disadvantages of this procedure include a need for multiple visits and reducing root resistance after a long-term contact between calcium hydroxide and root dentin [11,12,36]. For these reasons, the use of MTA in teeth with necrotic pulps and open apices has been considered [37].…”

“…According to G. Erdem et al, in 2009 [40], in three cases, the clinical and radiographic examinations of the horizontally root-fractured teeth treated with MTA used as an apical barrier revealed asymptomatic and excellent healing patterns after 36-month follow -up. A case from the report of R. Rothom and P. Chuveera [12], one from K. Er [41] and three cases from A. Kusgoz [42], showed favorable outcomes. A research of D. Kim et al, in 2015 [43] showed that of the 22 root-fractured teeth received endodontic treatment with MTA, 19 cases participated in the follow-up for a period of at least 3 months.…”

Conservative Management of the Horizontal Root Fracture in the Middle Third using Fiber Post as an Intraradicular Splint

“…[3] A clinician must also check for the severity of trauma and the pulp vitality. [3,6] Root fractures present clinically as a slightly extruded tooth, often palatally displaced. The tooth is often mobile, but the degree of mobility is frequently determined by the fracture location.…”

“…[3] Additional radiographs with increased or decreased vertical angulation of 15 degrees are specifically suggested for diagnosis of the angle of fracture. [6] The American Academy of Pediatric Dentistry suggests performing a radiographic examination using different angulations and projections (periapical with 90al with 90ne is seenocclusal view, and periapical with distal or mesial angulation). [7] Widening of the fracture line, loss of lamina dura, and rarefaction of the adjacent alveolar bone are typical radiographic findings.…”