Root FractureRoot Fracture

Root FractureRoot Fracture• Clinical findings: Coronal segment may be Clinical findings: Coronal segment may be

mobile/displaced. Percussion positive. Bleeding mobile/displaced. Percussion positive. Bleeding from the sulcusfrom the sulcus

• Radiographic findings: horizontal fractures Radiographic findings: horizontal fractures detected with 90 degree film. Oblique fracture detected with 90 degree film. Oblique fracture ( often in apical third) require occlusal view or ( often in apical third) require occlusal view or varying horizontal radiographs.varying horizontal radiographs.

• Treatment: Reposition coronal segment promptly. Treatment: Reposition coronal segment promptly. Confirm reposition radiographically. Splint for 4 Confirm reposition radiographically. Splint for 4 weeks. Fractures in cervical third require weeks. Fractures in cervical third require stabilization up to 4 months. Monitor pulpal stabilization up to 4 months. Monitor pulpal status for one year. If necrotic endodontic therapy status for one year. If necrotic endodontic therapy on the coronal segment to the fracture line.on the coronal segment to the fracture line.

Root Fracture follow upRoot Fracture follow up• Follow up: 4 weeks remove splint, clinical and Follow up: 4 weeks remove splint, clinical and

radiographic exam. 8 weeks clinical and radiographic exam. 8 weeks clinical and radiographic exam. 4 months remove splint on radiographic exam. 4 months remove splint on fractures in the cervical third. Then clinical and fractures in the cervical third. Then clinical and radiographic exam at 6 months, 1 year and 5 radiographic exam at 6 months, 1 year and 5 years.years.

• Favorable outcome: positive pulp test at 3 Favorable outcome: positive pulp test at 3 months. Signs of repair of the fractured months. Signs of repair of the fractured segments.segments.

• Negative outcome: Symptomatic, negative Negative outcome: Symptomatic, negative pulp test, extrusion of coronal segment, pulp test, extrusion of coronal segment, radiolucency at fracture line. Need for radiolucency at fracture line. Need for endodontic therapy. endodontic therapy.

Alveolar FractureAlveolar Fracture

Alveolar FractureAlveolar Fracture• Clinical findings: fracture involves the alveolar Clinical findings: fracture involves the alveolar

bone and may extend to adjacent bone. Segment bone and may extend to adjacent bone. Segment mobility and dislocation with several teeth mobility and dislocation with several teeth moving together. Drastic change in occlusion.moving together. Drastic change in occlusion.

• Radiographic findings: Several PA angulations, Radiographic findings: Several PA angulations, occlusal film and panoramic radiograph needed occlusal film and panoramic radiograph needed to determine the course and position of fracture to determine the course and position of fracture lines.lines.

• Treatment: Reposition segment and splint, suture Treatment: Reposition segment and splint, suture gingival lacerations. Stabilize segment for 4 gingival lacerations. Stabilize segment for 4 weeksweeks

Alveolar Fracture: Alveolar Fracture: follow upfollow up

• Follow up: 4 weeks remove splint do clinical Follow up: 4 weeks remove splint do clinical and radiographic exam. Follow closely with and radiographic exam. Follow closely with clinical and radiographic exam at 8 weeks, 4 clinical and radiographic exam at 8 weeks, 4 months, 6 months, 1 year and 5 years.months, 6 months, 1 year and 5 years.

• Favorable outcome: positive pulp tests after Favorable outcome: positive pulp tests after 3 months. No signs of PA pathology3 months. No signs of PA pathology

• Unfavorable outcome: Symptomatic Unfavorable outcome: Symptomatic negative pulp test after 3 months. PA lesion negative pulp test after 3 months. PA lesion or external inflammatory root resorption. or external inflammatory root resorption. Endodontic therapy needed.Endodontic therapy needed.