Root Fracture Various radiographic views help to demonstrate the extent of the fracture or fractures. The location of the root fracture determines the prognosis of the tooth. If the fracture is close to the root tip, there is a better chance for maintaining pulp vitality and for success. If the fracture does not result in the two pieces of the root being separated, there is also a better chance for success. However, the closer the fracture is to the crown, regardless of whether or not the pieces are separated, the poorer the prognosis. Root canal treatment may be necessary and the tooth will likely need to be stabilized with a splint. Follow-up pulpal evaluation is recommended at periodic intervals. An immature root with an open apex has opportunity for pulp survival. Pulp necrosis is infrequent in the fractured immature tooth with an open apex.

Root Fracture Clinical findings: Coronal segment may be mobile/displaced. Percussion positive. Bleeding from the sulcus Radiographic findings: horizontal fractures detected with 90 degree film. Oblique fracture ( often in apical third) require occlusal view or varying horizontal radiographs. Treatment: Reposition coronal segment promptly. Confirm reposition radiographically. Splint for 4 weeks. Fractures in cervical third require stabilization up to 4 months. Monitor pulpal status for one year. If necrotic endodontic therapy on the coronal segment to the fracture line.

Root Fracture follow up Follow up: 4 weeks remove splint, clinical and radiographic exam. 8 weeks clinical and radiographic exam. 4 months remove splint on fractures in the cervical third. Then clinical and radiographic exam at 6 months, 1 year and 5 years. Favorable outcome: positive pulp test at 3 months. Signs of repair of the fractured segments. Negative outcome: Symptomatic, negative pulp test, extrusion of coronal segment, radiolucency at fracture line. Need for endodontic therapy.

Alveolar Fracture

Alveolar Fracture Clinical findings: fracture involves the alveolar bone and may extend to adjacent bone. Segment mobility and dislocation with several teeth moving together. Drastic change in occlusion. Radiographic findings: Several PA angulations, occlusal film and panoramic radiograph needed to determine the course and position of fracture lines. Treatment: Reposition segment and splint, suture gingival lacerations. Stabilize segment for 4 weeks

Alveolar Fracture: follow up Follow up: 4 weeks remove splint do clinical and radiographic exam. Follow closely with clinical and radiographic exam at 8 weeks, 4 months, 6 months, 1 year and 5 years. Favorable outcome: positive pulp tests after 3 months. No signs of PA pathology Unfavorable outcome: Symptomatic negative pulp test after 3 months. PA lesion or external inflammatory root resorption. Endodontic therapy needed.