PAEDIATRIC DENTISTRY - 3rd Ed. (2005)

(John Hannent) #1

Complicated crown-root fracture


As above with the addition of endodontic requirements. If extrusion is planned then
the final root length must be no shorter than the final crown length otherwise the
result will be unstable. Root extrusion can be successful in a motivated patient and
leads to a stable periodontal condition.


Root fracture


Root fractures occur most frequently in the middle or the apical third of the root. The
coronal fragment may be extruded or luxated. If displacement has occurred the
coronal fragment should be repositioned as soon as possible by gentle digital
manipulation and the position checked radiographically. Optimal repositioning
favours both healing with hard tissue and reduces the risk of pulpal necrosis. Mobile
root fractures need to be splinted to encourage repair of the fracture. With the possible
exception of coronal third fractures which may require longer splinting periods, it
appears that a period of 4 weeks with a semi-rigid or functional splint is sufficient to
ensure healing. A functional splint is one that includes one abutment teeth on either
side of the fractured tooth. Splinting for longer periods may be required in individual
cases. The splint should allow colour observations and sensitivity testing and access
to the root canal if endodontic treatment is required. The splint design and placement
techniques are discussed in the next section on 'splinting'.


Three main categories of repair are recognized:



  1. repair with calcified tissue: invisible or hardly discernible fracture line (705HFig. 12.28
    (a)-(c));

  2. repair with connective tissue: narrow radiolucent fracture line with peripheral
    rounding of the fracture edges (706HFig. 12.29);

  3. repair with bone and connective tissue: a bony bridge separates the two fragments
    (707HFig. 12.30).


In addition to these changes in the fracture area, pulp canal obliteration is commonly
seen. Fractures in the cervical third of the root will repair as long as no
communication exists between the fracture line and the gingival crevice. If such a
communication exists then splinting is not recommended and an early decision must
be made either: to extract the coronal fragment and retain the remaining root;
internally splint the root fracture; or extract the two fragments.


EXTRACTION OF CORONAL FRAGMENT AND ROOT RETENTION
The remaining radicular pulp should be removed and the canal temporarily dressed
prior to obturating with gutta percha. Three options are now available for the root
treated radicular portion:



  1. Post, core, and crown restoration if access is adequate.

  2. Extrusion of root either surgically or orthodontically if the fracture extends too

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