Root fracture - Treatment Guidelines
Localization of fracture line
- An occlusal exposure is optimal for locating root fractures in the apical and middle third.
- Bisecting angle exposure or 90o degree angulation exposure is needed to locate fractures in the cervical third of the root.
Treatment
For root fractures where the coronal fragment have been avulsed out of the socket please use the treatment guidelines for avulsion otherwise proceed as described below.
- Rinse exposed root surface with saline before repositioning.If displaced, reposition the coronal segment of the tooth as soon as possible.
- Check that correct position has been reached radiographically.
- Stabilize the tooth with a flexible splint for 4 weeks. If the root fracture is
near the cervical area of the tooth stabilization is benificial for a longer period of time (up to 4 months).
- Monitor healing for at least 1 year to determine pulpal status. If pulp necrosis develops, then root canal treatment of the coronal tooth segment to the fracture line is indicated.
Patient instructions
- Soft food for 1 week
- Good healing following an injury to the teeth and oral tissues depends, in part, on good oral hygiene. Brushing with a soft brush and rinsing with chlorhexidine 0.1 % is beneficial to prevent accumulation of plaque and debris.
Follow-up
- Splint removal and clinical and radiographic control after 4 weeks in apical third and mid-root fractures. However, if the root fracture is near the cervical area the splint should be kept on for up to 4 months.
- Clinical and radiographic control after 6-8 weeks.
- Clinical and radiographic control after 4 months. If the root fracture is near the cervical area the splint should be removed at this session.
- Clinical and radiographic control after 6 months, 1 year and yearly for 5 years.
- Follow-up may include endodontic treatment of the coronal fragment if pulp necrosis develops. The decision for endodontic treatment may be taken after three months of follow-up if the tooth still does not respond to electrometric or thermal pulp testing and if radiographs show a radiolucency next to the fracture line.