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Immature maxillary central incisors with horizontal root fractures and coronal fragment avulsion: a case study Natrah Ahmad Fuad Marialena Cresta Angus Walls Dental Update 2025 52:6, 419-428.
Authors
Natrah AhmadFuad
BDS (Malaya), DClinDent (Endodontology) (Edinburgh), MEndo RCS (Edinburgh), MFDS RCS (Edinburgh), Department of Restorative Dentistry, Faculty of Dentistry, Universiti Malaya; Department of Restorative Dentistry, Edinburgh Dental Institute
BDS, MFDS RCPS (Glasgow), MMedSci (Edinburgh), MEndo RCS (Edinburgh), AFHEA, Senior Clinical Lecturer/Honorary Consultant in Endodontics, Training Programme Director DClinDent in Endodontology, Department of Restorative Dentistry, Edinburgh Dental Institute
PhD (Newcastle), BDS (Newcastle), FDSRCS (England), FDSRCS (Edin), FHEA, Emeritus Professor of Restorative Dentistry, Department of Restorative Dentistry, Edinburgh Dental Institute
In this case study, a 19-year-old female patient with severe dental anxiety presented for a dental trauma review subsequent to an injury to the UR1 and UL1 9 years previously. This case was managed conservatively from the outset by periodic reviews. During the reviews, both the UR1 and UL1 showed no signs of infection or inflammation, but there was evidence of pulp canal obliteration in both teeth. Radiographic assessments showed healing at the fracture sites, although the apical fragment of the UL1 appeared distally displaced, which was evident from the 11-month review onwards. In addition to the trauma management, the patient was seen in a joint hypodontia clinic for potential orthodontic treatment. After 9 years, the UR1 and UL1 remained responsive to pulp sensibility tests and were asymptomatic, with no signs of infection or inflammation.
CPD/Clinical Relevance: The importance of periodic post-trauma reviews, comprehensive treatment planning, conservative management of traumatized, immature permanent teeth is highlighted.
Article
Traumatic dental injuries (TDI) rank as the sixth most prevalent injury worldwide.1 Avulsion leads to the rupture of the pulp's neurovascular supply, causing nutritional insufficiency and cellular deterioration.2
Nonetheless, because of their significant vascularity, immature teeth with open apices possess the capacity for revascularization. The anastomosis of pulp and periodontal tissues facilitates blood flow to the ischaemic pulp tissue, so repair can be initiated.3 Extra-oral time of short duration and the presence of an open apex improve the prognosis of avulsed teeth.
Root fractures, conversely, entail damage to the dentine, cementum and pulp, and may be vertical or transverse, and encompass both horizontal and oblique fractures.4,5 Horizontal root fractures may be classified as supracrestal, subcrestal, middle third or apical third, with supracrestal root fractures having the most unfavourable prognosis.5
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