Abstract : Purpose : Horizontal root fracture is a pathological condition caused by impact on the crown of the tooth due to trauma, and often requires root canal treatment, in which case closure of the fracture part is also required. We report on the 5-year prognosis of a tooth with horizontal root fracture due to trauma, which did not cause apical periodontitis and hard tissue formation was observed at the fracture part despite inadequate root canal treatment 10 years ago.
Case : The maxillary right central incisor had suffered trauma 10 years ago, but recently the patient came to our clinic because the discoloration of the tooth had become severe. Electric pulp test, cold test, and thermal pulp test of the incisor showed negative reactions. In addition, no percussion pain or periapical tenderness was observed. Periodontal pocket test and mobility test were within normal limits. Radiographic examination showed a fracture at the center of the root of the maxillary right central incisor, but no X-ray transmission images were observed. CBCT findings revealed a bone-like high-density image between the dissected tooth roots. Based on the clinical examination findings, the affected tooth was the maxillary right central incisor, the pulp was diagnosed as previously initiated therapy, and the apical periodontal tissue was diagnosed as normal. The cause of the discoloration was diagnosed as endogenous local discoloration due to pulp necrosis. As treatment, we decided to perform root canal treatment up to the fracture part and bleaching using the walking bleach method. The patient’s chief complaint was resolved by bleaching treatment after root canal treatment. At the 5-year postoperative follow-up, a slight reversion of the color tone was observed. Postoperative evaluation using CBCT showed that the fracture site was progressing well.
Discussion : In this case, it was not possible to accurately determine the condition of the tooth root fracture at the time of injury. However, because 10 years had passed since the injury, there were no clinical symptoms, and there were no X-ray transmission images of the fracture or root apex, it was thought that there was almost no bacterial infection within the root canal.
Conclusion : In the case of horizontal root fracture occurring within the bone, the progress is good if there is no bacterial infection within the root canal, reconfirming that bacterial infection is the problem with endodontic treatment.
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