Root Canal Treatment in India

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Fracture of Root
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FRACTURE OF ROOT If the fracture is in the
apical third of the root, the prognosis is
favorable, provided the tooth is immobilized and
it is not placed under undue pressure during
mastication. The apposing tooth or teeth should
be ground down, to minimize incisal-occlusal
stress.
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• Splinting may be done by ligating the fractured
  tooth to several adjacent teeth by extracoronal
  ligation. Several different methods can be used
• acid etch technique cementation of plastic
  orthodontic brackets in composite, wired
  together with .01 dead-soft stainless steel wire
  and reinforced with resin
• acid-etch technique cementation of bonded
  resin with ligation using 20-Ib monofilament
  plastic fishline and
• 3) Solid facial bonding of crowns of teeth
  adjacent to each other

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Orthodontic band wire ligation, or acrylic or
cast splint cementation. The splint should be
removed in 3 to 6 weeks, depending on the status
of the alveolar bone surrounding the tooth, tooth
mobility, and the overall root length of the
tooth. The pulps of such teeth should be checked
periodically for vitality, and radiographs should
be taken. In most cases, the pulp remains vital.

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When a fracture occurs in the middle or coronal
third of the root, the prognosis is less
favorable because of the difficulty of
immobilizing the tooth. Repair does not occur
because of the constant movement of the tooth, as
well as exposure of the pulp to the oral
environment. In time, the tooth becomes loose and
must be removed, or it may even be completely
exfoliated as resorption occurs.
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A tooth whose root is fractured in its apical
third has an excellent prognosis because the pulp
in the apical fragment usually remains vital, and
the tooth may remain firm in its socket. A mobile
tooth should be ligated. If the pulp in the
coronal fragment remains vital and the tooth is
stable, with or without ligation, then no
additional treatment will be indicated.
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In the event that the pulp in the coronal
fragment dies, then endodontic treatment can be
done, preferably limited to the coronal fragment.
If the tooth fails to recover the apical root
fragment can be removed surgically
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Andreasen described three types of root repair
following treatment of root fracture 1.
Calcified tissue 2. Connective tissue 3.
Granulomatous tissue
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Vertical Fracture Vertical fracture of
posterior teeth is not as amenable to
conservative endodontic treatment as horizontal
fracture diagnosis is often difficult to
establish by radiograph, percussion, or other
means. In most cases, the patient complains of
sensitivity and may or may not be able to locate
the affected tooth. The tooth may react normally
to the electric pulp test, or it may become
hypersensitive.
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In the early stage, when hair line fracture is
present and before separation of the fragments is
evident, no radiographic changes are visible
either in the tooth or in the adjacent bone. At
times, Having the patient chew on a cotton
applicator or rubber polishing wheel helps in
identifying the tooth.
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The prognosis of a tooth with a longitudinal
(vertical) fracture depends on the location of
the fracture. If the fracture passes through the
clinical crown of a multirooted tooth and through
its furcation, the prognosis may be favorable,
provided the tooth can be hemisected. For
example, a buccolingual fracture through the
crown of a mandibular molar,
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Extending into the bifurcation, can be treated.
By endodontic therapy, followed by hemi section
and full coverage restoration of the mesial and
distal segments,
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Luxated Teeth Luxation is the displacement or
dislocation of a tooth from its socket. Luxation
may be partial, in which the tooth is partly
displaced from its socket, or total, in which the
tooth is completely avulsed from its socket.
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