Root Fractures

Question 1

What percentage of dental injuries do root fractures account for?

Answer 1

7%

Question 2

What teeth are most frequently affected by root fractures?

Answer 2

Upper central incisors

Question 3

Who is typical patient affected by root fractures?

Answer 3

11 to 20-years-old

Question 4

Why are root fractures less common in patients below this age?

Answer 4

Their bone is more elastic

Question 5

What are 3 classifications of root fractures?

Answer 5

Hard tissue healing after root fracture, connective tissue healing after root fracture, and non-healing due to infection in line of fracture

Question 6

What type of trauma usually results in a root fracture?

Question 7

If coronal fragment is displaced in which direction has it usually gone?

Answer 7

Palatally and in a slightly extruded direction

Question 8

What are 2 factors that determine healing?

Answer 8

Whether pulp is severed and whether bacteria has invaded fracture line

Question 9

What happens if pulp is intact after injury?

Answer 9

A dentin callus is formed between two fragments after some weeks, whereafter peripheral aspect of fracture is healed by cementum deposition, a process which can take place over a period of several years

Question 10

What happens if pulp has been ruptured?

Answer 10

Revascularization of coronal aspect of pulp has to take place prior to fracture healing

Question 11

What happens if bacteria gain access to coronal pulp in its avascular condition?

Answer 11

Healing of pulp is impossible and an accumulation of granulation tissue between root fragments will result as a response to infected coronal aspect of pulp

Question 12

What 2 factors does treatment depend on?

Answer 12

Level of fracture and degree of displacement of coronal fragment

Question 13

What is required where mobility is greater than grade 1?

Answer 13

Splinting

Question 14

What will a displaced fragment require?

Answer 14

Splinting once it has been repositioned to immobilise it in correct position and allow healing

Question 15

What does more coronal fracture line mean?

Answer 15

More likely that mobility will be present

Question 16

What 2 factors predict prognosis for pulpal healing?

Answer 16

Stage of root development at time of injury and dislocation of coronal fragment

Question 17

From most to least likely, what 3 complications occur in root fractures?

Answer 17

Pulp necrosis, progressive root resorption, and loss of marginal bone support

Question 18

What risk factors, if any, predict their likelihood?

Question 19

What are common complications of root fractures?

Answer 19

Pulp death and pulp obliteration

Question 20

What are mature dislocated root fractures most likely to undergo?

Answer 20

Pulp necrosis but root treatment can be undertaken, where coronal fragment only is prepared

Question 21

What are 2 types of resorption?

Answer 21

One indicating healing (within canal) and other suggesting further treatment is required

Question 22

What is need with some cervical (coronal) third fractures?

Answer 22

Permanent interproximal fixation usually in form of a bonded retainer/coronal fragment may be extracted, root portion root-filled and a post-crown placed