Tooth trauma is a common reason for visiting the dentist, especially in childhood and adolescence. Taking into account the anatomical and physiological features of teeth in a changeable bite, ongoing teething, unclosed root tips and active growth of the child's dentition as a whole, an important task of the dentist is to preserve the viability of the injured tooth, return it to its proper aesthetics and function.
Sometimes trauma to the coronal part of the tooth is accompanied by dislocation, subluxation of the tooth or root fracture. In case of dislocation and subluxation, it is necessary to reposition the teeth, temporarily suture them and monitor the condition of the pulp. In case of her death, endodontic treatment is carried out.
Root fracture - a more formidable complication and treatment tactics are adopted depending on the location of the fracture (cervical part, middle or apical third), its type (longitudinal, transverse or oblique) and the stage of root development (patient's age).
In cases of cervical fractures, endodontic treatment, orthodontic traction or surgical lengthening of the coronal part of the tooth can be used, followed by the manufacture of a pin construction and an artificial crown.
In case of fractures in the apical third and death of the pulp, it is necessary to carry out endodontic treatment and periapical microsurgical intervention aimed at removing a fragment of a tooth.
Difficulties in fractures of the middle third of the root are associated with the choice of treatment tactics, and, unfortunately, are often incorrect. Quite often, patients with such fractures undergo tooth extraction. Sometimes it is impossible to avoid extraction, but if the pulp of the tooth has retained its vitality, especially in children and young people, there is a chance to save the tooth. Therapeutic measures should be aimed at immobilizing the tooth (temporary splinting) and controlling its vitality. The pulp in young people has a pronounced plastic function (dentin formation), therefore, there is a high probability of fusion of root fragments.
And only in the case of the death of the pulp, it is necessary to carry out endodontic treatment or tooth extraction.
Below is a clinical case of a tooth root fracture in the middle third in patient M., 10 years old.
The photo shows CT sections with a transverse root fracture in two projections. The teeth were splinted with the help of orthodontic wire, the condition of the tooth pulp is being monitored.
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