Root Fracture: Does It Need Root Canal Treatment or Not?

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WE HAD a rough winter with many snow storms this year. Unfortunately, with snow storms there are icy roads, and these slippery roads cause a lot of falls. After one of those snowy nights, a patient presented to me in pain after falling on an icy sidewalk while walking her dog. Upon examination, I noted that #7 and #10 had small mesial enamel fractures, #8 had a superficial enamel-dentin fracture and a midroot horizontal fracture, and #9 had an enamel-dentin fracture into the pulp chamber (Figures 1 and 2).

On Day 1, tooth #7 and tooth #10 tested normally (cold WNL, -palpation, -percussion, -mobility); #8 (cold WNL, -palp, ++percuss, +mobility); #9 (-cold, -palp, +percuss, -mobility). Since #8 had a horizontal fracture with slight mobility, a flexible splint was made from #7 to #9. Root canal treatment was started on #9, and calcium hydroxide was placed in the canal. An X-ray was taken of the patient’s upper lip to make sure that there were no pieces of the broken tooth in the lip. The patient was instructed to eat soft foods and to use 0.12 percent chlorhexidine mouth rinse twice a day for two weeks.

On Day 7, the patient presented to me with beautiful composite buildups which were out of occlusion. Teeth #7 and #10 were tested and found to be normal. Root canal treatment on #9 was finished (Figure 3), and the splint was taken off. Tooth #8 still tested vital, and percussion sensitivity was less symptomatic. No root canal treatment was needed at this time because the tooth was still vital. However, if the tooth had not responded to cold, then root canal treatment would have had to be done up to the horizontal fracture. The treatment would have stopped at the fracture because it is recommended that the apical portion be kept untreated because it usually stays vital. According to the guidelines of the American Association of Endodontists, followup should be done after three to four weeks, six to eight weeks, six months, one year, and then yearly for five years for root fractures. For crown fractures (fractures into the dentin or pulp), followup should be done in six to eight weeks and after one year.

On Week 4, teeth #7 through #10 were asymptomatic. Teeth #7, 8, and 10 were vital. Tooth #8’s mobility was normal, and percussion sensitivity was gone.

On Week 8, Teeth #7 through #10 were still asymptomatic. Teeth #7, 8, and 10 were vital. A periapical X-ray (Figure 4) was taken to make sure that there was no resorption and to give the okay for starting crown preparations. So far, root canal treatment has not been needed on tooth #8. Followup will be done in six months.

April - June 2011

Figure 1
FIGURE 1: Pre-op.
Figure 1
FIGURE 2: Pre-op.
Figure 3
FIGURE 3: Post-op.
Figure 4
FIGURE 4: Eight-week follow-up.