J Dent Rehabil Appl Sci.  2024 Nov;40(4):249-256. 10.14368/jdras.2024.40.4.249.

Use of mineral trioxide aggregate in the treatment of horizontal root fracture with a 4-year follow-up: case report

• Kang ES

• KMID: 2562769
• DOI: http://doi.org/10.14368/jdras.2024.40.4.249

Abstract

Root fracture is a rare case of dental trauma, occurring mainly in the maxillary anterior teeth, and comprise only 0.5 - 7% of traumas affecting permanent tooth. When a horizontal root fracture is diagnosed through radiological examinations, a splint is placed on the adjacent teeth and the progress is observed. If pulp necrosis of the fractured coronal fragment occurs, root canal treatment is performed. Calcium hydroxide or mineral trioxide aggregate (MTA) can be used at this time. In this case report, a maxillary central incisor with a horizontal root fracture was filled with MTA and followed up for 4 years. The tooth was maintained without any clinical symptoms or loss during the 4-year follow-up period.

Keyword

denta trauma; horizontal root fracture; MTA; CBCT

Figure

• 

  Fig. 1 Initial radiographs. (A) Panorama view. (B) Periapical radiograph showing the horizontal root fracture.

• 

  Fig. 2 Working Length determination radiograph for evaluation of the level of labial fracture line with #45-K file (A) and the level of palatal fracture line with #110-K file (B).

• 

  Fig. 3 Digital periapical radiographs of MTA obturation in coronal root fragment. (A) Checking the MTA obturation status, (B) Immediately after MTA obturation, (C) Core builds-up after a week of MTA obturation.

• 

  Fig. 4 (A) Periapical radiograph after two-years of MTA obturation, (B) Periapical radiograph after four-years of MTA obturation.

• 

  Fig. 5 The sagittal (left) and frontal (right) CBCT slices of maxillary left central incisor. (A) CBCT images immediately after MTA obturation, (B) CBCT images after four-years of MTA obturation.

Reference

References

1. Andreasen FM, Andreasen JO. Andreasen JO, Andreasen FM, Andreasen L, editors. Crown fractures. Textbook and Color atlas of Traumatic Injuries to the Teeth. 4th ed. Copenhagen: Munksqaard;2007. p. 219–56.

2. Saoud TM, Mistry S, Kahler B, Sigurdsson A, Lin LM. 2016; Regenerative Endodontic Procedures for Traumatized Teeth after Horizontal Root Fracture, Avulsion, and Perforating Root Resorption. J Endod. 42:1476–82. DOI: 10.1016/j.joen.2016.04.028. PMID: 27576211.

3. Taori P, Nikhade P, Chandak M, Ikhar A, Mahapatra J. 2022; Management of Untreated Horizontal Root Fracture: A Case Report. Cureus. 14:e28133. DOI: 10.7759/cureus.28133.

4. Yildirim T, Gençoğlu N. 2009; Use of mineral trioxide aggregate in the treatment of horizontal root fractures with a 5-year follow-up: report of a case. J Endod. 35:292–5. DOI: 10.1016/j.joen.2008.11.004. PMID: 19166793.

5. Andreasen JO, Hjorting-Hansen E. 1967; Intra alveolar root fractures: radiographic and histologic study of 50 cases. J Oral Surg. 25:414–26.

6. Roig M, Espona J, Mercadé M, Duran-Sindreu F. 2011; Horizontal root fracture treated with MTA, a case report with a 10-year follow-up. Dent Traumatol. 27:460–3. DOI: 10.1111/j.1600-9657.2011.01018.x. PMID: 21722306.

7. Calişkan MK, Pehlivan Y. 1996; Prognosis of root-fractured permanent incisors. Endod Dent Traumatol. 12:129–36. DOI: 10.1111/j.1600-9657.1996.tb00111.x. PMID: 9028190.

8. Giudice RL, Lizio A, Cervino G, Fabiana N, Francesco P, Ausiello P, Cicciù M. 2018; The horizontal root fractures. diagnosis, clinical management and three-year follow-up. Open Dent J. 12:687–95. DOI: 10.2174/1745017901814010687. PMID: 30369978. PMCID: PMC6182880.

9. Majorana A, Pasini S, Bardellini E, Keller E. 2002; Clinical and epidemiological study of traumatic root fractures. Dent Traumatol. 18:77–80. DOI: 10.1034/j.1600-9657.2002.180206.x. PMID: 12184216.

10. Andreasen JO, Andreasen FM, Andersson L. Textbook and Color Atlas of Traumatic Injuries to the Teeth. 5th ed. New jersey: John Wiley & Sons;2018.

11. Torabinejad M, Chivian N. 1999; Clinical applications of mineral trioxide aggregate. J Endod. 25:197–205. DOI: 10.1016/S0099-2399(99)80142-3. PMID: 10321187.

12. Kim KB, Kim SM, Choi NK, Yang KH. 2007; Treatment for root fracture on the immature maxillary permanent central incisor. J Korean Acad Pediatr Dent. 34:454–60.

13. Rothom R, Chuveera P. 2017; Differences in Healing of a Horizontal Root Fracture as Seen on Conventional Periapical Radiography and Cone-Beam Computed Tomography. Case Rep Dent. 2017:2728964. DOI: 10.1155/2017/2728964. PMID: 28744379. PMCID: PMC5514331.

14. Molina JR, Vann WF Jr, McIntyre JD, Trope M, Lee JY. 2008; Root fractures in children and adolescents: diagnostic considerations. Dent Traumatol. 24:503–9. DOI: 10.1111/j.1600-9657.2008.00652.x. PMID: 18821952.

15. Diangelis AJ, Andreasen JO, Ebeleseder KA, Kenny DJ, Trope M, Sigurdsson A, Andersson L, Bourguignon C, Flores MT, Hicks ML, Lenzi AR, Malmgren B, Moule AJ, Pohl Y, Tsukiboshi M. International Association of Dental Traumatology. 2012; International Association of Dental Traumatology guidelines for the management of traumatic dental injuries: 1. Fractures and luxations of permanent teeth. Dent Traumatol. 28:2–12. DOI: 10.1111/j.1600-9657.2011.01103.x.

16. Görduysus M, Avcu N, Görduysus Ö. 2008; Spontaneously healed root fractures: two case reports. Dent Traumatol. 24:115–6. DOI: 10.1111/j.1600-9657.2007.00497.x. PMID: 18173680.

17. Andreasen FM, Andreasen JO. Andreasen JO, Andreasen FM, editors. Root fractures. Textbook and Color Atlas of Traumatic Injuries to the Teeth. 3rd ed. Copenhagen: Munksgaard;1994. p. 279–311.

18. Cvek M, Mejàre I, Andreasen JO. Conservative endodontic treatment of teeth fractured in the middle or apical part of the root. Dent Traumatol. 2004; 20:261–9. DOI: 10.1111/j.1600-9657.2004.00272.x. PMID: 15355385.

19. Abd-Elmeguid A, Yu DC. 2009; Dental pulp neurophysiology: Part 2. current diagnostic tests to assess pulp vitality. J Can Dent Assoc. 75:139–43.

20. Camp JH, Barett EJ, Pulver F. Cohen S, Burns RC, editors. Pediatric endodontics: Endodontic treatment for the primary and young, permanent dentition. Pathways of the Pulp. 8th ed. St. Louis: Mosby;2002. p. 797–844.

21. Hatibović-Kofman S, Raimundo L, Zheng L, Chong L, Friedman M, Andreasen JO. 2008; Fracture resistance and histological findings of immature teeth treated with mineral trioxide aggregate. Dent Traumatol. 24:272–6. DOI: 10.1111/j.1600-9657.2007.00541.x. PMID: 18410392.

22. Kusgoz A, Yildirim T, Tanriver M, Yesilyurt C. 2009; Treatment of horizontal root fractures using MTA as apical plug: report of 3 cases. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 107:e68–72. DOI: 10.1016/j.tripleo.2009.01.031. PMID: 19426911.

23. Andreasen JO, Ahrensburg SS, Tsilingaridis G. 2012; Root fractures: the influence of type of healing and location of fracture on tooth survival rates - an analysis of 492 cases. Dent Traumatol. 28:404–9. DOI: 10.1111/j.1600-9657.2012.01132.x. PMID: 22443169.

24. May JJ, Cohenca N, Peters OA. 2013; Contemporary management of horizontal root fractures to the permanent dentition: diagnosis - radiologic assessment to include cone-beam computed tomography. Pediatr Dent. 35:120–4. DOI: 10.1016/j.joen.2012.10.022.

25. Bornstein MM, Wölner-Hanssen AB, Sendi P, Von Arx T. 2009; Comparison of intraoral radiography and limited cone beam computed tomography for the assessment of root-fractured permanent teeth. Dent Traumatol. 25:571–7. DOI: 10.1111/j.1600-9657.2009.00833.x. PMID: 19843131.