One of the most distressing situations is when young patients show up in my office after a traumatic injury with fractured upper anterior teeth. The balance between reassuring parents, managing the pain and discomfort of the patient, and making treatment recommendations is a juggling act. For me, I have always approached these situations with a heavy heart, believing that the prognosis for these young people is ongoing dental issues as a result.
Recently, I became aware of incredibly positive science in regards to how horizontal root fractures heal. In patients between the ages of 7-17 who experience a horizontal root fracture, with minimal intervention we can predict that some 70% will heal and preserve the natural tooth throughout their lifetimes.
The survival of these teeth is dependent to a variety of fractures. If the two pieces are still approximated closely and the less the coronal piece has been luxated the better the chances of healing without loss of pulp vitality. If there has been bodily movement of the coronal piece, moving it back into position is critical. The less mobility present in the coronal portion, the higher the chance of healing. There also seems to be evidence that girls have a higher chance of the tooth healing then boys, but this may be associated with the fact that girls seem to experience trauma at a younger age generally then boys.
Lastly, Splinting of the coronal portion through bonding for the first four weeks, increases the chances of tooth survival. The current recommendation in these types of injuries is careful observation, splinting, and routine follow-up to assess for healing and pulp vitality.
This new awareness also helps me rest assured when I see radiographic evidence of a horizontal root fracture in adults, long after a trauma they can not even remember. If the tooth is vital and asymptomatic, leave well enough alone.
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