Orthodontic movement of a maxillary central incisor with a horizontal root fracture treated using an intra-radicular fibre splint
A 15-year-old boy with class II division 1 malocclusion was referred from the unit of Orthodontics for evaluation of a 2-year-old, asymptomatic, horizontal root fracture in the left maxillary central incisor, prior to undergoing fixed orthodontic treatment []. There was a history of trauma at the age of 13 years due to fall during play a recent intra-oral peri-apical radiograph revealed a horizontal root fracture at the junction of apical and middle-thirds of 21 showing a type 1 healing pattern with evidence of calcific nodules narrowing the pulp space []. On clinical examination, the tooth was found to be grade 1 mobile with no discoloration or tenderness to percussion. The electric pulp test showed the pulp of 21 to be vital. Three treatment options were considered for its management prior to orthodontic intervention (i) surgical removal of the apical fragment and endodontic treatment of the coronal segment, (ii) no treatment of the segments and observe the response to orthodontic forces and later carry out the above mentioned procedures, if required, (iii) endodontic treatment of both the fragments, if feasible and placement of a fiber post-splint. It was possible to negotiate both the fragments with the endodontic files, though with difficulty []. The apical 3 mm was sealed with mineral trioxide aggregate and a fiber post (3M, Rely X) measuring nearly 10 mm and at least 2-3 mm beyond the fracture site, was placed in the canal and sealed with resin modified light cure glass ionomer cement (3M) []. The coronal access was sealed with composite. Patient was then later subjected to orthodontic forces for correction of an over jet of nearly 7 mm, which involved both retraction and torque control, to which he responded favorably with both fragments moving as a unit [Figures -].