If the fracture is in the apical third of the root, the prognosis is favorable, provided the tooth is immobilized and it is not placed under undue pressure during mastication. The apposing tooth or teeth should be ground down, to minimize incisal-occlusal stress.

6. Fracture of Root

7. FRACTURE OF ROOT
If the fracture is in the apical third of the root, the
prognosis is favorable, provided the tooth is
immobilized and it is not placed under undue
pressure during mastication. The apposing tooth or
teeth should be ground down, to minimize incisal-
occlusal stress.

9. Splinting may be done by ligating the fractured
tooth to several adjacent teeth by extracoronal
ligation. Several different methods can be
used:
(1) acid etch technique cementation of plastic
orthodontic brackets in composite, wired
together with .01 dead-soft stainless steel wire
and reinforced with resin
(2) acid-etch technique cementation of bonded
resin with ligation using 20-Ib monofilament
plastic fishline and
3) Solid facial bonding of crowns of teeth adjacent
to each other

10. Orthodontic band wire ligation, or acrylic or cast
splint cementation. The splint should be removed in
3 to 6 weeks, depending on the status of the
alveolar bone surrounding the tooth, tooth mobility,
and the overall root length of the tooth. The pulps of
such teeth should be checked periodically for
vitality, and radiographs should be taken. In most
cases, the pulp remains vital.

11. When a fracture occurs in the middle or coronal third
of the root, the prognosis is less favorable because
of the difficulty of immobilizing the tooth. Repair does
not occur because of the constant movement of the
tooth, as well as exposure of the pulp to the oral
environment. In time, the tooth becomes loose and
must be removed, or it may even be completely
exfoliated as resorption occurs.

12. A tooth whose root is fractured in its apical third has
an excellent prognosis because the pulp in the apical
fragment usually remains vital, and the tooth may
remain firm in its socket. A mobile tooth should be
ligated. If the pulp in the coronal fragment remains
vital and the tooth is stable, with or without ligation,
then no additional treatment will be indicated.

13. In the event that the pulp in the coronal fragment
dies, then endodontic treatment can be done,
preferably limited to the coronal fragment. If the
tooth fails to recover the apical root fragment can
be removed surgically

14. Andreasen described three types of root repair
following treatment of root fracture
1. Calcified tissue
2. Connective tissue
3. Granulomatous tissue

16. Vertical Fracture:
Vertical fracture of posterior teeth is not as amenable to
conservative endodontic treatment as horizontal fracture
diagnosis is often difficult to establish by radiograph,
percussion, or other means. In most cases, the patient
complains of sensitivity and may or may not be able to
locate the affected tooth. The tooth may react normally
to the electric pulp test, or it may become
hypersensitive.

17. In the early stage, when hair line fracture is present
and before separation of the fragments is evident, no
radiographic changes are visible either in the tooth or
in the adjacent bone. At times, Having the patient
chew on a cotton applicator or rubber polishing wheel
helps in identifying the tooth.

18. The prognosis of a tooth with a longitudinal (vertical)
fracture depends on the location of the fracture. If
the fracture passes through the clinical crown of a
multirooted tooth and through its furcation, the
prognosis may be favorable, provided the tooth can
be hemisected. For example, a buccolingual
fracture through the crown of a mandibular molar,

19. Extending into the bifurcation, can be treated. By
endodontic therapy, followed by hemi section and
full –coverage restoration of the mesial and distal
segments,

20. Luxated Teeth
Luxation is the displacement or dislocation of a
tooth from its socket. Luxation may be partial, in
which the tooth is partly displaced from its socket, or
total, in which the tooth is completely avulsed from
its socket.