Case Report

Case Report on Management of Fractured Root and Root Resorption Using MTA

Nandhini Kumar*, Chandini Devi Sridharan, Shafie Ahamed A, Bhavani S and Rajaraman G

Department of Conservative Dentistry and Endodontics, Rajah Muthiah Dental College and Hospital, Annamalai university, Cuddalore, India

Submission: June 08, 2023; Published: June 20, 2023

*Corresponding author: Nandhini Kumar, G1/1 old Suham Appartment, Annamalai Nagar, Cuddalore, India, E-mail: nanendo2020@gmail.com

How to cite this article: Nandhini Kumar, Chandini Devi Sridharan, Shafie Ahamed A, Bhavani S, Rajaraman G. Case Report on Management of Fractured Root and Root Resorption Using MTA. Adv Dent & Oral Health. 2023; 16(2): 555933. DOI: 10.19080/ADOH.2023.16.555933

Abstract

Root fracture occurs due the horizontal impact and forces are in transverse to oblique direction. Root fracture is the uncommon injury that occurs in 0.5-7% of all dental trauma cases. Middle third fracture is the most common among the root fracture. Treatment options various for different types of fracture. Biocompatible material which has excellent sealing property and tissue regeerating capacity should be used. This case deals the management of horizontal root fracture with root resorption using a biocompatible material.

Background: Horizontal root fracture occurs in most of dental trauma cases that too in maxillary anterior teeth due to tooth position, early intervention and treatment is required. Delay in treatment lead to resorption. Proper endodontic treatment and biocompatible material should be used for treating this type of case.

Methods: Orthograde endodontic management of external inflammatory root resorption was attempted.

Results: Healing with hard tissue formation occurred in this case after one month. This denotes the positive outcome of the treatment.

Conclusion: The primary objective of endodontic treatment is to prevent and intercept pulpal/periradicular pathosis and to preserve the natural dentition when affected by pathosis. Treatment outcome is positive for this case.

Keywords: Horizontal root fracture; MTA; Resorption; Trauma

Introduction

Root fracture accounts only 0.5-7% of all dental trauma cases [1-3]. Root fracture is defined as “fracture involving dentin, cement and pulp” [1]. Maxillary central incisor is commonly involved in fracture cases (approximately 68%). The next in frequently involved teeth are the maxillary lateral incisors (27%) followed by mandibular incisors (5%) [4,5]. Horizontal root fracture is commonly involved middle third of root [6]. An impact forces on the top of the root and frontal forces affect the compression zone labially and lingually/ palatally, thus dividing the root into coronal and apical segment leads to root fracture [7]. Diagnosis should be done based on proper clinical diagnosis and radiographic evaluation. Mobility of tooth and pulp vitality should be checked during clinical examination. On radiographic evaluation, radiolucent line will be visible separating the apical and coronal segment [8,9]. To finalize the fracture detection two or three radiographs taken at different angulations to be done.

Case Report

The treatment of horizontal root fracture depends on the location of the fracture, mobility and vitality of tooth. Coronal segment fracture shows severe mobility and extraction of fracture segment. Apical third root fracture display no mobility and generally require no treatment. Middle third root fracture has a favourable prognosis. If the coronal segment is displaced, the initial management should be repositioning the fragment, followed by stabilization to allow healing of the surrounding periodontal tissues [1]. If treatment gets delayed for root fracture led to resorption near fractured segment. The AAE Glossary of Terms defines Resorption as physiologic or pathologic loss of dentin, cementum, and/or bone not immediately due to caries or trauma (AAE Glossary). Resorption occurs when developmental precementum or predentin are lost or damaged and inflammation of the adjacent soft tissues allows for clastic cell invasion [10]. Andreasen classified tooth resorption as Internal (inflammatory, replacement and surface), external (inflammatory, replacement, surface and cervical) and combined [11]. There are two stages in resorption: degradation of inorganic matrix followed by disintegration of organic matrix [12]. Internal root resorption is a progressive destruction of intraradicular dentin and dentinal tubules along the middle and apical third of canal wall as the result of clastic activity. Earlier management lead to good prognosis [13-25].

Calcium hydroxide is commonly used intra canal medication for disinfecting the root canal system. Application of calcium hydroxide paste at the interval of seven days eliminate or reduce the bacterial content after biomechanical preparation. When used in resorption management case its alkaline pH actively influences the local environment around a resorptive area by reducing osteoclast activity and stimulating repair. The alkaline calcium hydroxide neutralizes the acidic environment which exists in the region of resorption, reversing the reaction and thus stimulating hard tissue formation. The diffusion of hydroxyl ions released by calcium hydroxide through the dentinal tubules that directly communicate with periodontal space would increase the pH of periodontal space from 6.0 to 7.4 - 9.6. MTA is a biocompatible material which has high pH and sealing capacity, low solubility, ability to present in the presence of the blood and incudes the odontoblastic differentiation by activating the transforming growth factor beta 1 (TGF-b1).

Conclusion

This paper insight case report on management of fractured root and perforating root resorption using MTA.

References

1. Andreasen FM, Andreasen JO (1994) Crown fractures, in Textbook and Color Atlas of Traumatic Injuries to the Teeth, Munksgaard, Copenhagen, Denmark, 3^rd edition pp. 219-256.
2. Davidovich E, Heling I, Fuks AB (2005) The fate of a mid-root fracture: a case report. Dental Traumatology 21(3): 170-173.
3. Alis¸kan MKC (2004) Prognosis of large cyst-like periapical lesions following nonsurgical root canal treatment: a clinical review. Int Endod J 37(6): 408-416.
4. Andrade ES, Sobrinho ALPDC, Andrade MGS, Matos JLF (2008) Root healing after horizontal fracture: a case report with a 13-year follows up. Dent Traumatol 24(4): e1-e3.
5. Alis¸kan MKC Pehlivan Y (1996) Prognosis of root-fractured permanent incisors, Endod Dent Traumatol 12(3): 129-136.
6. Bramante CM, Menezes R, Moraes IG, Bernardinelli N, Garcia RB, et al. (2006) Use of MTA and intracanal post reinforcement in a horizontally fractured tooth: a case report. Dent Traumatol 22(5): 275-278.
7. Welbury RR, Kinirons MJ, Day P, Humphreys K, Gregg TA (2002) Outcomes for root-fractured permanent incisors: a retrospective study. Pediatr Dent 24(2): 98-102.
8. Molina JR, Vann WF, McIntyre JD, Trope M, Lee JY (2008) Root fractures in children and adolescents: diagnostic considerations. Dent Traumatol 24(5): 503- 509.
9. Flores MT, Andersson L, Andreasen JO (2007) Guidelines for the management of traumatic dental injuries. I. Fractures and luxations of permanent teeth. Dent Traumatol 23(2): 66-71.
10. American Association of Endodontists. Glossary of Endodontic Terms, 10^th
11. Tronstad L (1988) Root resorption-etiology, terminology and clinical manifestations. Endod Dent Traumatol 4: 241-252.
12. Fernandes M, de Ataide I, Wagle R (2013) Tooth resorption part I-pathogenesis and case series of internal resorption. J Conserv Dent 16: 4-8.
13. Mankar DN, Jogad DN, Chute DA, Patil DA, Gade DV, et al. (2014) Management of horizontal root fracture: two case reports. IOSR Journal of Dental and Medical Sciences 13(4): 1-4.
14. Michanowicz AE (1963) Root fractures. A report of radiographic healing after endodontic treatment. Oral Surg Oral Med Oral Pathol 16(10): 1242-1248.
15. Cvek M (1974) Treatment of non-vital permanent incisors with calcium hydroxide. IV. Periodontal healing and closure of the root canal in the coronal fragment of teeth with intra-alveolar fracture and vital apical fragment. A follow-up, Odontologisk Revy 25(3): 239-246.
16. Andreasen JO, Hjorting-Hansen E (1967) Intraalveolar root fractures: radiographic and histologic study of 50 cases, J Oral Surg 25(5): 414-426.
17. Welbury R, Kinirons MJ, Day P, Humphreys K, Gregg TA (2002) Outcomes for root fractured permanent incisors: A retrospective study. Pediatr Dent 24(2): 98-102.
18. Zachrisson BU, Jacobsen I (1975) Long term prognosis of 66 permanent anterior teeth with root fracture. Scand J Dent Res 83: 345-354.
19. Torabinejad M, Watson TF, Pitt Ford TR (1993) Sealing ability of a mineral trioxide aggregate when used as a root end filling material. J Endod 19(12): 591-595.
20. Silveira FF, Nunes E, Soares JA, Ferreira CL, Rotstein I (2009) Double ‘pink tooth’ associated with extensive internal root resorption after orthodontic treatment: a case report. Dent Traumatol 25(3): e43-47.
21. Cvek M (1974) Treatment of non-vital permanent incisors with calcium hydroxide. IV. Periodontal healing and closure of root canal in the coronal fragment of teeth with intra-alveolar fracture and vital apical fragment. Odontol Revy 25: 239-246.
22. Tronstad L, Andreasen JO, Hasselgren G, Kristenson L, Riis I (1981) pH changes in dental tissues after root canal filling with calcium hydroxide. Journal of Endodontics 7: 17-21.
23. Hsien HC, Cheng YA, Lee YL, Lan WH, Lin CP (2003) Repair of perforating internal resorption with mineral trioxide aggregate: a case report. J Endod 29(8): 538-539.
24. Sari S, Sonmez D (2006) Internal resorption treated with mineral trioxide aggregate in a primary molar tooth: 18-month follow-up. J Endod 32: 69-71.
25. Silveira FF, Nunes E, Soares JA, Ferreira CL, Rotstein I (2009) Double ‘pink tooth’ associated with extensive internal root resorption after orthodontic treatment: a case report. Dent Traumatol 25(3): 43-47.