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References

Bauss O, Rohling J, Schwestka-Polly R Prevalence of traumatic injuries to the permanent incisors in candidates for orthodontic treatment. Dent Traumatol. 2004; 20:61-66
Andreasen JO, Andreasen FM, Andersson L, 4th edn. Oxford: Blackwell, Munksgaard; 2007
Andreasen FM Pulpal healing after luxation injuries and root fracture in the permanent dentition. Endod Dent Traumatol. 1989; 5:111-131
Flores MT, Andersson L, Andreasen JO, Bakland LK, Malmgren B, Barnett F Guidelines for the management of traumatic dental injuries. 1. Fractures and luxations of permanent teeth. Dent Traumatol. 2007; 23:66-71
Andreasen JO, Andreasen FM, Mejare I, Cvek M Healing of 400 intra-alveolar root fractures. 2. Effect of treatment factors such as treatment delay, repositioning, splinting type and period and antibiotics. Dental Traumatol. 2004; 20:203-211
Andreasen JO, Andreasen FM, Mejare I, Cvek M 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. Dent Traumatol. 2004; 20:192-202
Welbury R, Kinirons MJ, Day P, Humphreys K, Gregg TA Outcomes for root-fractured permanent incisors: a retrospective study. Paediatr Dent. 2002; 24:98-102
Andreasen JO, HjØrting-Hansen E Intra-alveolar root fractures: radiographic and histologic study of 50 cases. J Oral Surg. 1967; 25:414-426
Kindelan SA, Day PF, Kindelan JD, Spencer JR, Duggal MS Dental trauma: an overview of its influence on the management of orthodontic treatment. Part 1. J Orthod. 2008; 35:68-78
Heling I, Slutzky-Goldberg I, Lustmann J, Ehrlich Y, Becker A Bone-like tissue growth in the root canal of immature permanent teeth after traumatic injuries. Endod Dent Traumatol. 2000; 16:298-303

A case series: the orthodontic management of central incisors with horizontal root fractures

From Volume 43, Issue 7, September 2016 | Pages 648-657

Authors

Louise C Kneafsey

BDS, MFDS(Ed), MSc(Lon), MOrth RCS(Eng), FDS RCS(Eng)

Senior Specialist Registrar Orthodontics, Orthodontic Unit, Division of Craniofacial and Development Sciences, Eastman Dental Hospital/Institute, 256 Gray's Inn Road, London WC1X 8LD, UK

Articles by Louise C Kneafsey

Samantha J Hodges

BDS, MOrth RCS(Edin), MOrth RCS(Eng), FDS RCS(Orth) FHEA

Consultant, Orthodontic Unit, Division of Craniofacial and Development Sciences, Eastman Dental Institute, 256 Gray's Inn Road, London WC1X 8LD, UK

Articles by Samantha J Hodges

Abstract

This case series illustrates the successful orthodontic management of previously root-fractured central incisors. Orthodontic treatment was carried out to correct the underlying malocclusion, remove traumatic occlusal forces and to provide a suitable occlusion for future restorative treatment should the root-fractured teeth be lost in the future.

CPD/Clinical Relevance: Dental trauma occurs commonly; having affected 10% of orthodontic patients. All practitioners should be able to discuss the possibility of orthodontic treatment with patients who have had previous trauma to their front teeth.

Article

The percentage of the population presenting for orthodontic treatment with previous dental trauma has been reported to be as high as 10.3%.1 Root fractures in the permanent dentition account for 0.5–7% of all dental trauma2 and usually occur as a result of direct horizontal impact to the tooth or jaws.

Root fractures are most commonly seen in males in the 11–20 years age group and predominantly affect the middle third of the root of the upper incisors.2,3 Commonly, the root-fractured tooth presents with slight extrusion because the direction of impact tends to force the coronal fragment palatally, and the pulp can be stretched or severed. Pulp necrosis occurs in 20–44% of cases.2

Root fractures can be classified according to:

Horizontal root fractures are more likely in the permanent dentition when teeth have closed apices.2 The International Association of Dental Traumatology (IADT) recommends splinting teeth with a root fracture for 4 weeks with a flexible splint, unless the root fracture is near the cervical area of the tooth when it may benefit from a longer period of splinting (up to 4 months).4 Horizontal fractures in the middle third of the root have a better prognosis than vertical fractures.

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