Skip to main content

Advertisement

SpringerLink
Log in

Healing and long-term prognosis of root-fractured permanent teeth: a retrospective longitudinal study

  • Research
  • Published:
Clinical Oral Investigations Aims and scope Submit manuscript

Abstract

Aim

The purpose of the present study was to evaluate permanent teeth with post-traumatic transversal root fractures, for their initial healing modality, the effect of candidate predictors and their long-term prognosis.

Methodology

A retrospective longitudinal clinical study was conducted to evaluate records from patients bearing transversal root fractures in permanent teeth in order to radiographically assess short-term healing and non-healing events in the fracture line, their prognostic factors and their relationship with long term outcomes. The inter-fragmentary tissues were classified as healing: hard tissue (HT), connective tissue (CT) or connective tissue and bone (CT + B) and non-healing: interposition of granulation tissue (GT). A competing risk survival analysis was conducted to estimate the hazards of healing and non-healing events in the short-term and the effect of demographic, clinical, and treatment variables was assessed using the subdistribution regression model (Fine & Gray).

Results

Radiographic findings showed 61.4% of healing in the short-term being strongly influenced by the presence and type of concomitant injuries to the coronal fragment. Teeth with concomitant crown fractures (sHR 24.38, 95% CI [3.16–188.3], p = 0.0022), luxations with dislocations (sHR 10.58, 95% CI [1.37–81.9], p = 0.0240) and subluxations (HR 9.66, 95% CI [1.14–81.7], p = 0.0370) were more likely to present non-healing of root fractures in the short-term. The healing rate in the long-term was of 75.9%, most of them with interposition of bone and connective tissue. Kappa statistics demonstrated an overall agreement of 67.1% between short and long-term healing patterns, in special HT and CT + Bone modalities.

Conclusion

Healing at the fracture site was the most frequent outcome, both in the short-term and in the long-term. Short-term healing modality was strongly influenced by the presence and type of concomitant injuries to the crown fragment, being the worst prognosis observed in root-fractured teeth with concomitant crown fractures, followed by concomitant luxations with dislocation.

Clinical relevance

Post-traumatic transversal root fractures have a positive prognosis supporting therefore, a more conservative approach for these teeth before considering more radical treatments.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

Data availability

The following elements are available upon request: data extracted from clinical records, data used for all analyses and the analytic code. Contactinfo: Juliana Vilela Bastos, julianavbtrauma@gmail.com.

References

  1. Heithersay AO, Geoffrey S, Kahler B (2013) Healing responses following transverse root fracture: a historical review and case reports showing healing with (a) calcified tissue and (b) dense fibrous connective tissue. Dent Traumatol 29(4):253–265

    Article  PubMed  Google Scholar 

  2. Abbott PV (2019) Diagnosis and management of transverse Root fracture. JournalofEndodontics, v. 45. https://doi.org/10.1016/j.joen.2019.05.009

  3. Andreasen JO, Hjørting–Hansen E (1967) Intraalveolar root fractures: radiographic and histologic study of 50 cases. Journal Oral Surgery, Copenhagen, 25:414 – 26

  4. Andreasen FM, Andreasen JO (1988) Resorption and mineralization processes following root fracture of permanent incisors. EndodDentTraumatol 4:202–214

    CAS  Google Scholar 

  5. Andreasen FM, Andreasen JO, Bayer T (1989) Prognosis of root-fractured permanent incisors-prediction of healing modalities, vol 5. Endodontics Dental Traumatology, Copenhagen, pp 11–22

    Google Scholar 

  6. Andreasen (2001) Pulp healing acute following dental trauma: clinical and radiographic review. PractProcedSesthetDent 13:315–322

    CAS  Google Scholar 

  7. Cvek M, Mejare I, Andreasen JO (2002) Healing and prognosis of teeth with intra-alveolar fractures involving the cervical part of the root. DentTraumatol 18:57–65

    Google Scholar 

  8. Cvek M, Mèjare I, Andreasen JO (2004) Conservative endodontic treatment of teeth fractured in the middle or apical part of the root. DentTraumatol 20:261–269

    CAS  Google Scholar 

  9. Cvek M, Tsilingaridis G, Andreasen JO (2008) Survival of 534 incisors after intra alveolar root fracture in patients aged 7–17 years. DentTraumatol 24:379–387

    Google Scholar 

  10. Yates JA (1992) Root fractures in permanent teeth: a clinical review, vol 25. InternationalEndodonticsJournal, Oxford, pp 150–157

    Google Scholar 

  11. Caliskan MK, Pehlivan Y (1996) Prognosis of root-fractured permanent incisors. Endodontics Dent Traumatol Cph 12(3):129–136. https://doi.org/10.1111/j.1600-9657.1996.tb00111.x

    Article  CAS  Google Scholar 

  12. Welbury R, Kinirons MJ, Day P, Humphreys K, Gregg TA (2002) Outcomes for root-fractured permanent incisors: a retrospective study. PediatrDent 2:98–102

    Google Scholar 

  13. Cvek M, Andreasen JO, Borum MK (2001) Healing of 208 intra-alveolar root fractures in patients aged 7–17 years. DentTraumatol 17:53–62

    CAS  Google Scholar 

  14. Feely L, Mackie IC, Macfarlane T (2003) An investigation of root-fractured permanent incisor teeth in children. DentTraumatol 19:52–54

    Google Scholar 

  15. Andreasen FM, Andreasen JO, Cvek M, Mejare I (2004) Healing of 400 intra alveolar root fractures. 2. Effect of treatment factors such as treatment delay, repositioning, splinting type and period and antibiotics. Dental Traumatology, Copenhagen, 20:203 – 11. https://doi.org/10.1111/j.1600-9657.2004.00278.x

  16. Majorana A, Pasini S, Bardellini E, Keller E (2002) Clinical and epidemiological study of traumatic root fractures. Dent Traumatol 18:77–80. https://doi.org/10.1034/j.1600-9657.2002.180206.x

    Article  CAS  PubMed  Google Scholar 

  17. Zachrisson BU, Jacobsen I (1975) Long-term prognosis of 66 permanent anterior teeth with root fracture, vol 83. ScandinavianJournalDentistryResearch, Copenhagen, pp 345–354

    Google Scholar 

  18. Isaksson et al (2020) Effect of splinting times on the healing of intra-alveolar root fractures in 512 permanent teeth in humans: a scandinavian multicenter study. Dent Traumatol Cph 37:672–676. https://doi.org/10.1111/edt.12683

    Article  Google Scholar 

  19. Andreasen JO, Ahrensburg SS, Tsilingaridis G (2012) Root fractures: the influence of type of healing and location of fracture on tooth survival rates- an analysis of 492 cases. DentalTraumatol 28:404–409

    Google Scholar 

  20. Diangelis AJ et al (2012) International Association of Dental Traumatology guidelines for the management of traumatic dental injuries: 1. Fracturesandluxationsofpermanentteeth. In: DentTraumatol, 28:2–12

  21. Bastos JV, Goulart EM, Côrtes MIS (2014) Pulpal response to sensibility tests after traumaticdental injuries in permanent teeth. Dent Traumatol 30(3):188–192

    Article  PubMed  Google Scholar 

  22. Andreasen FM, Andreasen JO (1985) Diagnosis of luxation injuries. The importance of standardized clinical, radiographic and photographic techniques in clinical investigation. EndodDentTraumatol 1:160–169

    CAS  Google Scholar 

  23. Iqbal MK, Kim S (2008) A review of factors influencing treatment planning decisions of single-tooth implants versus preserving natural teeth with nonsurgical endodontic therapy. J Endod 34:519–529

    Article  PubMed  Google Scholar 

  24. Rosenquist B, Grenthe B (1996) Immediate placement of implants into extraction sockets: implant survival. Int J Oral MaxillofacImplants 11:205–209

    CAS  Google Scholar 

Download references

Acknowledgements

The authors confirm contribution to the paper as follows: Study conception and design: N. O. M Pedrosa, J.V. Bastos; Analysis and interpretation of results: N.O.M Pedrosa, R. A Santos, E.A. Colosimo, J.V. Bastos; Draft manuscript preparation: N. O. M Pedrosa, S.C. Coste, J.V. Bastos. All authors have reviewedand approved the final version of the manuscript.

Funding

No funding was obtained for this study, with the exception of scholarships provided to undergraduate and postgraduate students. This study received support fromCoordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), a Brazilian funding agency.

Author information

Authors and Affiliations

  1. Restorative Dentistry Department, School of Dentistry, Universidade Federal de Minas Gerais, R. Prof. Moacir Gomes de Freitas, 688, Pampulha, Belo Horizonte, MG, 31270-901, Brazil

    Natália de Oliveira Murta Pedrosa, Sylvia Cury Coste & Juliana Vilela Bastos

  2. Statistics Department, Institute of Exact Sciences, Universidade Federal de Minas Gerais, Belo Horizonte, 31270-901, Brazil

    Rayner Afonso Santos & Enrico Antônio Colosimo

Authors
  1. Natália de Oliveira Murta Pedrosa
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Rayner Afonso Santos
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sylvia Cury Coste
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Enrico Antônio Colosimo
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Juliana Vilela Bastos
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

The authors confirm contribution to the paper as follows: Study conception and design: N.O.M Pedrosa, J.V. Bastos; Analysis and interpretation of results: N.O.M Pedrosa, R. A. Santos. Colosimo, J.V. Bastos; Draft manuscript preparation: N.O.M. Pedrosa, S.C. Coste, J.V. Bastos. All authors have revised and approved the final version of the manuscript.

Corresponding author

Correspondence to Juliana Vilela Bastos.

Ethics declarations

Ethical approval

Study approval was obtained from COEP-UFMG − 4.384.144.

Patient consent statement

All study participants and/or their legal guardians have provided consent and signed the terms of consent and assent for participation in the study and authorization to use their data in the research. These documents will be made available upon request.

Conflict of interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Permission to reproduce material from other sources

Not applicable.

Clinical trial registration

Not applicable.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Pedrosa, N., Santos, R., Coste, S. et al. Healing and long-term prognosis of root-fractured permanent teeth: a retrospective longitudinal study. Clin Oral Invest 28, 209 (2024). https://doi.org/10.1007/s00784-024-05581-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s00784-024-05581-x

Keywords

Search

Navigation