Healing of 400 intra‐alveolar root fractures. 1. Effect of pre‐injury and injury factors such as sex, age, stage of root development, fracture type, location of fracture and severity of dislocation

Abstract

This retrospective study consisted of 400 root-fractured, splinted or non-splinted incisors in young individuals aged 7-17 years (mean = 11.5 +/- 2.7 SD) who were treated in the period 1959-1995 at the Department of Pediatric Dentistry, Eastman Dental Institute, Stockholm. Four hundred of these root fractures were diagnosed at the time of injury; and 344 teeth were splinted with either cap-splints, orthodontic appliances, bonded metal wires, proximal bonding with composite resin or bonding with a Kevlar or glass fiber splint. In 56 teeth, no splinting was carried out for various reasons. In the present study, only pre-injury and injury factors were analyzed. In a second study, treatment variables will be analyzed. The average observation period was 3.1 years +/- 2.6 SD. The clinical and radiographic findings showed that 120 teeth out of 400 teeth (30%) had healed by hard tissue fusion of the fragments. Interposition of periodontal ligament (PDL) and bone between fragments was found in 22 teeth (5%), whereas interposition of PDL alone was found in 170 teeth (43%). Finally, non-healing, with pulp necrosis and inflammatory changes between fragments, was seen in 88 teeth (22%). In a univariate and multivariate stratified analysis, a series of clinical factors were analyzed for their relation to the healing outcome with respect to pulp healing vs. pulp necrosis and type of healing (hard tissue vs. interposition of bone and/or PDL or pulp necrosis). Young age, immature root formation and positive pulp sensibility at the time of injury were found to be significantly and positively related to both pulpal healing and hard tissue repair of the fracture. The same applied to concussion or subluxation (i.e. no displacement) of the coronal fragment compared to extrusion or lateral luxation (i.e. displacement). Furthermore, no mobility vs. mobility of the coronal fragment. Healing was progressively worsened with increased millimeter diastasis between fragments. Sex was a significant factor, as girls showed more frequent hard tissue healing than boys. This relationship could possibly be explained by the fact that girls experienced trauma at an earlier age (i.e. with more immature root formation) and their traumas were of a less severe nature. Thus, the pre-injury or injury factors which had the greatest influence upon healing (i.e. whether hard tissue fusion or pulp necrosis) were: age, stage of root development (i.e. the size of the pulpal lumen at the fracture site) and mobility of the coronal fragment, dislocation of the coronal fragment and diastasis between fragments (i.e. rupture or stretching of the pulp at the fracture site).

Surgical Management of a Non-healing Intra-alveolar Root Fracture Associated with Pulpal Calcification and Root Resorption: A Case Report

“…Treatment approach for horizontal root fracture is complex and depends on degree of displacement of fracture fragment, patient's age, stage of root growth, mobility of the coronal fragment, and diastasis of the fragments [11]. Necrotic apical segment should be removed surgically if the remaining coronal root segment is long enough to provide adequate periodontal support.…”

Root fracture in patient in the pre-liver transplantation phase

“…The fractured tooth prognosis is influenced by factors such as the degree of dislocation, stage of root formation, fracture location, interval between trauma and treatment, and type of dental trauma 9 .…”

Post-Trauma Root Fracture in Teeth With Incomplete Root Development: A Case Report

“…It has been reported that recovery is experienced in 80% of cases, especially when horizontal root fractures are involved [3][4][5]. Vertical root fractures have a poor prognosis.…”

“…However, other patterns of the desired recovery involve the connective tissue, the connective tissue in conjunction with calcified tissue formation, and granulation tissue formation [1, 3,11]. It has been reported that in order for hard tissue formation to occur, the coronal fracture fragment must not be dislocated and pulp exposure should not occur.…”

“…Root fracture lines are classified as horizontal, oblique, vertical, and as horizontal/oblique. In addition, the type of root fracture is divided into single, complicated (≥2 fragments) and partial [1][2][3].…”