Abstract
Purpose: Conservative treatment of vertical root fractures (VRF) is challenging. Bonding treatments for VRF using adhesive materials have recently been reported. There are two types of bonding treatments for VRF: internal adhesive therapy, in which the fractured tooth is bonded nonsurgically through the root canal, and a combination of adhesive therapy and intentional replantation, in which the fractured tooth is extracted, bonded extraorally, and replanted. This report describes a long-term case of a mandibular molar with complete VRF successfully restored using adhesive therapy and intentional replantation.
Case: The patient was a 50-year-old female with a complaint of discomfort in the first molar of the left mandible. A sinus tract was observed in the buccal gingiva. The periodontal pocket depth was 9 mm on the buccal aspect of the mesial root and 3 mm in other areas, and the mobility was 0 degree. Dental radiography showed halo radiolucency around the mesial root. The condition was diagnosed as a complete VRF of the mesial root of the mandibular left first molar. Treatment methods included adhesive therapy and intentional replantation.
Treatment: The tooth was extracted with forceps to avoid damage to the periodontal ligament and immediately preserved in a preservative solution. The infected root canal contents and fractured surfaces were removed. The root canal and fractured fragments were bonded using a one-step adhesive and filled with a dual-cure core resin. A 0.9-mm U-shaped wire was embedded in the root canal for reinforcement. The end of the root apex was retro-filled with MTA. The tooth was replanted into the socket and loosely fixed using simple sutures. The stitches were removed after seven days. Three months after surgery, a dental radiograph showed a reduction in bone radiolucency; however, bone loss was observed in the root furcation area. One year and one month after surgery, dental radiography revealed bone formation around the mesial root, and bone radiolucency had almost disappeared. Four years and six months after surgery, a dental radiograph showed the lamina dura around the mesial root and bone formation in the root furcation area. Seven years and one month after surgery, no recurrence of the root fracture was observed on dental radiography.
Conclusion: Successful healing can be expected by applying adhesive therapy using a dual-cure core resin and a metal wire and intentional replantation of mandibular molars with complete VRF. The patient remains in good condition at seven years and one month of follow-up.
