Eighteen months postoperatively, in spite of pulpal involvement in the fractures, the tooth was still vital and apparently completely healthy. The trauma had caused several vertical fractures which traversed the gingival attachment. In an earlier case report by Hall, a central incisor in an 11-year-old male that was shattered into four pieces, was restored. Can the same processes work to heal vertical fractures that traverse the attachment? The above are horizontal root fractures that are entirely below the gingival attachment. One of these teeth was extracted and it showed, clinically, the formation of cementum and cementoid.Īndreasen and Hjørting-Hansen concluded that the two most important features in the successful treatment of root fractures are immediate reposition and fixation. In a study of 50 horizontal root fractures, they showed the apparent formation of new cementum, radiographically, when the fractured segments were in close apposition. Hammer studied tooth fractures in dogs and noted, after two weeks, dentin repair beginning on the pulpal side of the fracture, and cementum repair on the fracture line after three weeks.Īndreasen and Hjørting-Hansen demonstrated in a study published in 1967 that cementum healing apparently occurs in humans. There have been a few reports of such healing in the literature.
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Theoretically, then, if there is an injury to a root such as a crack, if the proper conditions are maintained, the potential exists for that crack to be able to heal over with new cementum We have known for a long time that cementum deposition occurs throughout life. Cementum is generated from the periodontal ligament. Roots are, of course, covered with cementum. This paper will challenge these assertions by offering literature citations and long-term case studies of up to twenty years which show conditions under which a split or fractured tooth can be completely salvaged, intact and fully healthy. This condition is nonresponsive to periodontal treatment.” As stated by Simon, Glick and Frank, “Once this attachment is breached and the groove becomes involved, a self-sustaining infrabony pocket can be formed along its length. The rationale is that when a fracture extends from the supragingival area to below the attachment, the fracture line can become a nidus for progressive inflammation. Then there is a good possibility that the small segment can be removed and the remainder of the tooth salvaged. If the fracture shears to a root surface that is not too far apical, the smaller segment will be very mobile. “If the fracture is severe (that is, deep apically), the tooth must be extracted. “Maintaining an intact tooth is impossible,” the text explains. As asserted by Walton, after the diagnosis of a split tooth is confirmed, saving the tooth is not an option. When a vertical tooth fracture extends below the gingival attachment, the recommended treatment has been extraction. See their case report, “ Complicated Tooth Fracture Management“, published in the IOSR Journal of Dental and Medical Sciences, July, 2015. Note: This research has been replicated by Divia, Joseph, and Varughese, at the University of Kerala, India. Journal of the Colorado Dental Association, Fall 2004 issue. The English version of this article was published in the 10-15.Ĭlick here for the Portuguese translation. This research was published in a Brazilian dental journal, Revista Paulista de Odontologia, Jan-Feb 2004, pp. Guilherme Itikawa is an endodontist practicing in Sao Paulo, Brazil.) Sergio Ourique is Chairman of the Department of Prosthodontics, University of Sao Paulo, Sao Paulo, Brazil.) David Hall is a dentist who practiced in Cedar Rapids, Iowa, and is now the owner and president of Infinity Dental Web of Phoenix, Arizona.) Restoration of fractured teeth -a long-term study.
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