Healing after horizontal root fractures: 3 cases with 2-year follow-up
A 13-year-old female patient was referred to the Department of Conservative Dentistry at the Wonkwang University Dental Hospital (Iksan, Korea) for the evaluation of her maxillary anterior teeth. Seven days previously, the maxillary central incisors were traumatized when she slipped on the stairs and fell down. The coronal fragments of the incisors were luxated laterally, thereby showing the exposed labial surface of the root. The patient's medical history was noncontributory. The emergency dentist diagnosed the teeth as having horizontal root fractures with alveolar bone fractures. The teeth were repositioned with a rigid splint ().\nOne week after the trauma, both teeth had a normal response to pulp vitality tests. Three weeks later, localized swelling was observed on the labial gingiva of the maxillary left central incisor, and a radiolucent lesion was present near the fracture line. Both teeth had no responses to the thermal and electronic pulp tests. The narrow and deep pocket (approximately 8 mm) were explored by a dental probe through the gingival sulcus to the swollen portion (). Root canal treatment was initiated on both coronal fragments of the teeth with K-file and irrigated with 5% sodium hypochlorite. Working length was established with an apex locator (DentaPort ZX). Calcium hydroxide was applied into the canals between appointments. The deep pocket was debrided because of the possibility of the insertion of a foreign body at the time of the accident. At the 2-month follow-up evaluation, the swelling had disappeared and pocket depth was reduced to 3 mm. The canals were obturated with MTA (ProRoot) confined to the coronal fragment ().\nAt the 6-month and 1-year follow-up evaluation, she did not complain of any pain. However, she reported occasional swelling of the gingiva of the maxillary left central incisor. Clinically normal probing depth and normal response to percussion were observed on the teeth. Radiographic examination showed that the radiolucent area near the fracture line of the maxillary left central incisor had decreased, but the lesion remained (). At the 1½-year evaluation, a fragment of tooth-like material was observed in the gingival swelling area and the fragment was removed. At the 2-year follow-up evaluation, she reported no recurrence of gingival swelling since her last visit to the dental hospital. Slight mobility remained, but both teeth were retained well in the maxillary arch without any discomfort. Radiographic examination showed the teeth were healed with soft tissue between the fragments ().