Clinical management of horizontal root fractures aided by the use of cone-beam computed tomography

• Published in: Giornale italiano di endodonzia 2017-11, Vol.31 (2), p.102-108
• Main Authors: Martos, Josué, Amaral, Luana P., Silveira, Luiz Fernando M., Damian, Melissa F., Xavier, Cristina B., Lorenzi, Alesandro
• Format: Article
• Language: English
• Subjects: Cone-beam computed tomography; Dental trauma; Diagnosi; Diagnosis; Frattura radicolare; Root fracture; Tomografia computerizzata a fascio Conico; Trattamento; Trauma dentale; Treatment
• ISSN: 1121-4171
• DOI: 10.1016/j.gien.2017.05.002

To present a a therapeutic approach in a case series of teeth that suffered some root fracture at different thirds with a follow-up period of 24 months. Dental trauma occurs with great frequency to the maxillary incisors, and, sometimes, horizontal root fractures are caused. The classification and severity of horizontal root fractures are based on the location of the fracture line and on the degree of dislocation of the coronal fragment. Diagnosis of horizontal root fractures is based on clinical findings, sensibility tests, and principally in radiographic and cone-beam computed tomography (CBCT) examination. The following cases report describes the diagnosis and treatment of four maxillary central incisors with horizontal root fractures. In three of the cases described, the healing occurred through the interposition of connective tissue where radiographically was possible to observe a radiolucent at the level of the fracture line and the rounding of the fragment angles. In one case, the healing occurred by calcified tissue, which can be seen radiographically in the fracture line, but the fragments are in close contact. In addition to a proper treatment plan, the International Association of Dental Traumatology (IADT) stresses the importance of patient compliance with follow-up, and daily care visits for better healing after dental trauma. Knowledge of existing protocols for this type of injury and periodic monitoring of cases has shown the success of the treatment so far. Key-learning points:(1)The diagnosis of root fractures requires a detailed examination, both clinical and radiographic.(2)The IADT developed a guideline in order to propose an effective treatment plan.(3)The CBCT facilitates the visualization of lines fracture.(4)An immediate approach after horizontal root fractures comprises reduction, splints and occlusal adjustment. Presentare un approccio terapeutico con una serie di casi di denti che hanno subito una frattura radicale a diversi livelli con un periodo di follow-up di 24 mesi. Il trauma dentale si presenta con una grande frequenza negli incisivi mascellari e, a volte, si possono verificano fratture di radice orizzontale. La classificazione e la gravità delle fratture di radice orizzontale si basano sulla posizione della linea di frattura e sul grado di dislocazione del frammento coronale. La diagnosi delle fratture di radice orizzontale è basata sui riscontri clinici, test di sensibilità e principalmente un esame radiografico intraora