Successful minimally invasive intervention in a primary central incisor after root fracture: A case report

Abstract

Tooth injuries are one of the main emergencies in pediatric dentistry, being a stressful situation for the child and family. 1 In the interaction with the environment and while learning to crawl and walk, trauma can be more frequent due to the child's characteristics: curiosity, restlessness, motor immaturity and lack of protection. Falls from height and hitting objects while playing are the most common causes of traumatic injuries in children aged 1-to 3-years-old. 2 The maxillary central primary incisors are the most affected teeth. 1,3 Root fractures are rare traumatic injuries (1-4%), affecting dentin, cementum, periodontal ligament and the pulp. 2 They follow vertical, oblique or horizontal orientations. The diagnosis is performed through clinical and radiographic examinations. 4 Mobility and pain on palpation if there is displacement of the coronal fragment are frequent. 5,6 The treatment of root fractures in primary teeth will depend on the location and direction. 3,5 For horizontal fractures in the apical and middle thirds, when promptly attended, fragments should be repositioned by digital pressure. However, if the patient presents late, a blood clot is usually present, which makes this maneuver more difficult. 7,8 Apical third fractures usually recover without treatment, but middle third fractures or when there is excessive mobility of the involved tooth, rigid splinting is necessary for a period of 90-120 days. 3,5,8 Some late complications are related to pulp canal obliteration, whether or not accompanied by pulp necrosis, with or without apical resorption, and it may even affect the developing tooth germ's formation. 5

Use of splinting in traumatized primary teeth: A systematic review of case reports

“…Of these, 59 full texts were evaluated and eight case reports were included in this systematic review (Figure 1). The case reports included in this review described the use of dental splinting in Brazilian (Di Giorgio et al, 2021;Bonanato et al, 2009;Santos et al, 2021), Indian (Pathak et al, 2016;Shanmugam et al, 2011), Turkish (Akin et al, 2011),…”

“…Chinese (Liu et al, 2013), and Greek (Chatzidimitriou et al, 2017) children (Table 2). Two studies described the use of splinting for the immobilization of laterally displaced teeth (Akin et al, 2011;Pathak et al, 2016), and four in teeth with root fractures (Bonanato et al, 2009;Liu et al, 2013;Santos et al, 2021;Di Giorgio et al, 2021). One study investigated the use of splints in the immobilization of a primary maxillary right central incisor with extrusive luxation -associated with the presence of root fracture (Di Giorgio et al, 2021).…”

Predictive factors for maxillofacial fractures, sedentary behavior, and dental trauma literacy

“…27 There is a lack of studies in the current literature on the management of root fractures in primary dentition, likely due to its low occurrence rate. 28,29 In this Issue, Kevci et al assessed the risks of complications such as pulp necrosis, pulp canal obliteration, ankylosis with replacement root resorption, infection-related root resorption, and premature tooth loss in primary teeth with root fracture and the risk of other possible sequelae in the permanent dentition following root fracture in the primary dentition. 30 In order to provide appropriate treatment to children, it is important to understand the risk of healing complications in primary teeth with root fractures.…”

“…The location of the fracture, mobility of the segment, and degree of displacement determine whether the coronal fragment should be extracted or the tooth left untreated 27 . There is a lack of studies in the current literature on the management of root fractures in primary dentition, likely due to its low occurrence rate 28,29 . In this Issue , Kevci et al assessed the risks of complications such as pulp necrosis, pulp canal obliteration, ankylosis with replacement root resorption, infection‐related root resorption, and premature tooth loss in primary teeth with root fracture and the risk of other possible sequelae in the permanent dentition following root fracture in the primary dentition 30 .…”

Management of oblique root fracture in the middle third of two maxillary immature central incisors with severe caries in mixed dentitions: a case report

“…Traumatic tooth injuries are one of the most prevalent emergencies in pediatric dentistry, frequently occurring during childhood and adolescence [1,2]. About 50% of injuries affect the hard tissues in the oral cavity, while 36% impact the soft tissues [3].…”