Horizontal root fracture

Root canal treatment on a traumatized 11, with a fractured crown. It was left opened for drainage by the referring dentist for a few days until the patient was due to see me. A horizontal root fracture at the apical third of the root was suspected.

I strongly opposed to this practice of open drainage, which is unscientific and unjustifiable. It is against the objectives of RCT, where asepsis and removal of microorganisms from the root canal system is the key to successful treatment of apical periodontitis. Once the tooth is left opened, more microbes, species and substrate will gain entry to the canal system and periradicular areas.

Since the tooth was left opened for a few days already, I had no choice but to do the RCT. According to Andreason, the apical fragment of the fractured root is usually vital and RCT is only performed up to the coronal fragment. In this case, since there is minimal displacement of the apical root fragment , RCT was carried out to the full root length. A thorough cleaning and shaping, and irrigating with NaOCl eliminated microbes that had entered the RCS and subsequently, the canal was medicated with CaOH for two weeks. During obturation, sealer escaped between the fracture and peri radicular radiolucency was observed associated with the fracture. An apical surgery to remove the fractured tip would be indicated if no resolution occurred at the periradicular area.

Luckily, the peri radicular lesion disappeared, as shown on the review pa radiograph after one year, indicating hard tissue repair around the fracture line, and the tooth is symptom free. Outcome of horizontal root fractures are generally favorable.