Root fractures tend to occur in older children and adolescents. In young children the bone is softer, so teeth tend to be displaced and luxated; however, as the bone becomes harder and teeth more brittle with age, then root fractures are more common.
- Take several radiographs at different angulations (Fig. 32.1).
- Check for both vertical and horizontal root fractures.
- Fractures may not be evident initially, it is only with inflammation and swelling that the fragments separate and are visible.
- Suspect a vertical root fracture when an isolated periodontal defect is present or there is inability to resolve a periapical infection.
Aim: to align fragments, provide stability and achieve healing.
- Reposition coronal fragment and splint rigidly for up to 12 weeks with composite resin and wire or orthodontic appliances.
- High apical fractures usually require no treatment (Fig. 32.2).
The apical portion of the fracture almost always retains its vitality.
- Hard tissue union between fragments (very uncommon).
- Interposition of bone (Fig. 32.3).
- Interposition of fibrous connective tissue.
- Granulation tissue between fragments – coronal pulp necrosis.