Root fracture and its management

Root fractures of the teeth are rare compared to other forms of dental trauma. In the primary dentition, root fractures usually occur between 3–4 years of age when root resorption has started. The incidence is reported to be 0.5–7% of all injuries in the permanent dentition.1 Root fractures are defined as those that involve cementum, dentine and pulp. Horizontal root fractures occur more often in the maxillary central incisors and are commonly found in the middle third of the root2 followed by the apical and coronal thirds. Root fractures can be classified according to the direction, extent, number or the portion of the root affected as shown in Table 1.

Root fractures involve damage to the pulp, dentine, cementum, bone and periodontium and usually occur as a result of a horizontal severe impact. These injuries are sometimes associated with other injuries, eg concomitant fracture of the alveolar process in the lower incisor region. The position of the fracture line and its communication with the gingival crevice are important factors in determining the long-term prognosis for the tooth. Long-term prognosis of fractures at the coronal or gingival third is poorer than for a root fracture in the middle or apical third.2^,3^,4 The chance of healing with calcified tissue is poor when the fracture is very close to or communicating with the gingival crevice.1 Root fractured teeth with immature roots have a better chance of healing compared to teeth with fully formed roots and the majority of the root fractured permanent teeth in children show good healing.5 An explanation could be that teeth with open apices have a greater potential for maintenance of pulp vitality than those with closed apices. Figures 1 and 2 show a maxillary central incisor with horizontal root fracture in the coronal third and middle third, respectively.