“In traumatic dental injuries, not only it is important to know when to treat a case (endodontically-speaking); it is equally important to know when not to treat it.” – Martin Trope
Before considering extraction of a tooth with root fracture, no matter how bad it looks on the x-ray, the following treatment approach must be considered in order to give the tooth another chance:
1) reduction: repositioning the tooth back into the socket,
2) fixation: stabilizing the tooth with a flexible splint for four weeks (if the fracture is in the middle or apical third area), or for four months (if the fracture is in the cervical third area),
3) relief of occlusion: to minimize further damage to the PDL and the protective layer of the root, and
4) recall: monitoring clinically and radiographically in 6-8 weeks, 4 months, 6 months, 1 year and yearly for 5 years.
After three months of follow-up, endodontic treatment of only the coronal segment should be considered if the tooth continues to be unresponsive to vitality testing, appears discoloured, and/or develops periapical pathosis (radiolucency) around the fracture line.
The tooth above has remained asymptomatic and functional 2 years after the endodontic treatment and 3 years after sustaining a traumatic injury. I always remind myself of what Ian Linde would say when considering all options for cases that appear hopeless on the radiograph: “Implants should replace missing teeth not teeth.”