25 February 2024 : Review article
Review of Approaches to the Management of Vertical Dental Root Fractures and Tooth Preservation
Besir Salihu
1ABDEF, Miranda Stavileci 2EF*
DOI: 10.12659/MSM.943100
Med Sci Monit 2024; 30:e943100
Table 1 Treatment approaches for vertical root fractures.
| Treatment modality | Description | Advantages | Disadvantages |
|---|---|---|---|
| No treatment, just observation with monitoring | Following the actual clinical condition without taking any step in the treatment | Least invasive option, allows assessment of the fracture’s stability | Tooth may become symptomatic or fail. Typically leads to tooth loss due to infection or complications |
| Root resection and root amputation | Removing apex of a tooth’s root, or the whole root of multi-rooted teeth | Tooth preservation, maintains the bone density, restores the function and is an alternative to extraction | Complex procedure, risk of residual infection which leads to limited success. Requires surgical skills |
| Hemisection | The surgical removal of one-half of a tooth, typically in multi-rooted teeth | Can save one portion of the tooth, cost-effective, conservation of healthy roots | May result in a gap if one portion is extracted, also it is a complex procedure |
| Laser fusion of vertical root fracture | Sealing the fracture line while generating thermal energy | Better alternative than extraction and no treatment | Is not a widely recognized or established dental procedure |
| Re-cementing, bonding or sealing the fractured fragment | Closing the fracture line with different approaches, with the aim of saving the tooth and sealing the fracture line so the bacteria does not enter | Minimally invasive, compared with resection and hemisection, even though it is often combined with these procedures. Cost-effective and preserves the tooth | Complex procedure, Requires good surgical skills and healthy periradicular tissues, some bacteria can remain within the fracture lines |
| Intentional replantation | Tooth is intentionally removed from its socket, treated or repaired, and then replanted back into its original position in the patient’s mouth | Preservation of natural tooth, less invasive than dental implants and requires fewer dental appointments | Risk of complications, success rates vary, potential for reinfection, risk of root resorption, not suitable for all cases |
| Prosthodontic rehabilitation (partial denture or bridge) | Focused on restoring or replacing missing teeth and associated oral structures to enhance oral function, aesthetics, and overall well-being | Provides a functional and aesthetic replacement of the lost tooth as a result of vertical root fracture | Alteration of adjacent healthy teeth, not suitable for single-tooth replacements, potential for discomfort or instability |
| Tooth extraction and implant placement | The most common treatment in vertical root fracture cases | Removes the source of infection and brings back the tooth function | Loss of the natural tooth and extra cost for the implant |