Root Fracture Follow-Up and Sequelae: What Happens After Healing?

Successful management of a root fracture does not end once the initial treatment is completed. Regular follow-up is essential because complications may develop later, even when the tooth initially appears to be healing normally (Davidovich et al., 2005).

Follow-Up After Root Fracture

Follow-up appointments should generally be scheduled at 4 weeks, 6–8 weeks, 6 months and 1 year following the injury (IADT, 2020). These appointments should include both clinical and radiographic examinations to monitor healing and identify any developing complications.

Common Sequelae of Root Fractures

The most commonly observed changes following root fractures include pulp canal obliteration, pulp necrosis and different forms of root resorption. Root resorption can occur as external resorption, internal resorption or replacement resorption (Berman, 2007).

Pulp Canal Obliteration

Pulp canal obliteration is one of the most frequently observed sequelae of root fractures, occurring in approximately 69–73% of cases (Welbury et al., 2002).

Clinically, the crown may develop a yellowish discoloration, while radiographically the pulp canal appears increasingly narrow or completely obliterated due to the deposition of hard tissue within the canal (McCabe & Dummer, 2012).

It is important to remember that the pulp remains vital in most cases of pulp canal obliteration. Therefore, if there are no additional pathological signs or symptoms, no further treatment is usually required (McCabe & Dummer, 2012).

Pulp Necrosis

Pulp necrosis can occur as a result of persistent inflammation or bacterial contamination at the fracture site. It has been reported in approximately 22% of cases (Andreasen et al., 2004).

During follow-up, signs of pulp necrosis may include the development of clinical symptoms, periapical radiolucency or radiolucency around the fracture site. In later stages, discoloration of the crown may also become apparent (Andreasen et al., 2004).

In immature teeth with incomplete root formation, arrested root development and an open apex may also indicate pulpal necrosis (Berman, 2007).

Root Resorption

Inflammatory changes following a root fracture can result in different forms of root resorption. External root resorption has been observed in approximately 60% of root-fractured teeth (Andreasen et al., 2007). It is usually self-limiting and may resolve within 1–2 years.

Another form of external root resorption is replacement resorption, also known as ankylosis. In this condition, there is no effective treatment available to reverse the resorption. The literature suggests that decoronation may be considered in appropriate cases to preserve the alveolar bone for future implant placement (Malmgren, 2000).

Internal root resorption is associated with chronic pulpal inflammation (Andreasen et al., 2007). Although it is less common following root fractures, it can sometimes be identified clinically by a pink discoloration of the crown (Ranka et al., 2012). Once detected, pulp extirpation and root canal treatment should be performed promptly to prevent further progression and possible root perforation (Berman, 2007).

Root fractures can present significant challenges in pediatric dentistry, making accurate diagnosis, appropriate treatment and regular follow-up essential for achieving the best possible outcome.

In primary teeth, the main treatment goal is to prevent further injury to the developing permanent successor. In permanent teeth, the priority is to preserve the tooth whenever possible by maintaining pulp vitality and promoting healing between the fractured root segments.

Understanding the different patterns of root fracture healing, recognizing potential sequelae and maintaining regular follow-up allows clinicians to identify complications early and provide timely treatment when necessary.

References

• Andreasen FM, Andreasen JO, Cvek M. Root fractures. In: Textbook and Color Atlas of Traumatic Injuries to Teeth. Andreasen FM, Andreasen JO, eds. Copenhagen: Blackwell Publishing Ltd, 2007: pp337–371.

• Andreasen, J.O., Andreasen, F.M., Mejàre, I. and Cvek, M., 2004. Healing of 400 intra‐alveolar root fractures. 1. Effect of pre‐injury and injury factors such as sex, age, stage of root development, fracture type, location of fracture and severity of dislocation. Dental Traumatology, 20(4), pp.192-202.

• Berman, L.H. (2007). Intra-alveolar root fractures. In: A Clinical Guideline to dental Traumatology. Berman, L.H., Bianco, L., Cohen, S. eds. Mosby Elsevier: pp51-71.

• Fuss, Z., Lin, S., Tsesis, I. (2007). Intra-alveolar root fractures. In: A Clinical Guideline to dental Traumatology. Berman, L.H., Bianco, L., Cohen, S. eds. Mosby Elsevier: pp12-26.

• McCabe, P.S. and Dummer, P.M.H., 2012. Pulp canal obliteration: an endodontic diagnosis and treatment challenge. International Endodontic Journal, 45(2), pp.177-197.