Horizontal root fracture
Emergency treatment
semirigid splint to adjacent teeth for 2 to 4 weeks.
Midroot and Apical Root Fractures
上半段做endo:
In the vast majority of cases, permanent necrosis occurs in the coronal segment, with only the apical segment remaining vital. Therefore, endodontic treatment is indicated in the coronal root segment unless periapical pathology is seen in the apical segment.
要有一個apical plug (apexification):
In most cases, the pulpal lumen is wide at the apical extent of the coronal segment so that long-term calcium hydroxide treatment or an MTA apical plug is indicated (see Apexification). The coronal segment is filled after a hard-tissue barrier has formed apically in the coronal segment and periradicular healing has taken place.
少數的case是上半段跟下半段都會壞死
In rare cases when both the coronal and apical pulp are necrotic, treatment is more complicated.
如果斷的地方很靠根尖，crown root ratio夠的話，可以手術移除斷片
In more apical root fractures, necrotic apical segments can be surgically removed. This is a viable treatment if the remaining coronal root segment is long enough to provide adequate periodontal support. Removal of the apical segment in midroot fractures leaves the coronal segment with a compromised attachment; endodontic implants have been used to provide additional support to the tooth.
Healing Patterns
1. Healing with calcified tissue. Radiographically, the fracture line is discernible, but the fragments are in close contact.
2. Healing with interproximal connective tissue. Radiographically, the fragments appear separated by a narrow radio- lucent line, and the fractured edges appear rounded.
3. Healing with interproximal bone and connective tissue. Radiographically, the fragments are separated by a dis- tinct bony ridge.
4. Interproximal inflammatory tissue without healing. Radiographically, a widening of the fracture line and/or a developing radiolucency corresponding to the fracture line becomes apparent.
The first three types of healing patterns are considered successful.
出處：
Cohen's Pathway of the Pulp 10th edition, 2011
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