MANAGEMENT

OF
FRACTURED TOOTH

Dr Urvashi Sodvadiya
Flow Chart
• Introduction
• Classification of tooth fracture
• Longitudinal tooth fracture
• Craze lines
• Cuspal fracture
• Crack tooth to split tooth
• Vertical fracture
Risk factors
Diagnosis
Management
• Transverse tooth fracture
• Horizontal root fracture
Classification of horizontal fracture
Diagnosis
 Treatment based on location
Spliting
Types of healing
Factors influences healing and prognosis
IATD Guidelines
• Enamel fracture
• Enamel-dentin fracture
• Enamel-dentin-pulp fracture
• Crown-root fracture without pulpal involvement
• Crown-root fracture with pulpal involvement
• Conclusion
• References
Introduction
 Longitudinal fracture Transverse fracture
Classified by AAE

Enamel fracture
craze lines;
Enamel-Dentin fracture
fractured cusp;
Enamel- dentin- pulp fracture
cracked tooth;
Crown-root fracture without pulpal involvement
split tooth; and
Crown-root fracture with pulpal involvement
vertical root fracture
Horizontal root fracture

Bader JD, Martin JA, Shugars DA. Preliminary estimates of the incidence and consequences of tooth fracture. J Am Dent Assoc 1995: 126: 1650–1654.
 Longitudinal tooth fracture

 Linear fractures that tend to grow and change over time

 The keys to saving these teeth are to know:

1. How to identify and classify cracks;
2. The characteristic signs and symptoms; and
3. How to detect the crack as early in its development as possible

Bader JD, Martin JA, Shugars DA. Preliminary estimates of the incidence and consequences of tooth fracture. J Am Dent Assoc 1995: 126: 1650–1654.
 Classification

From least to most severe:

(1) craze lines;

(2) fractured cusp;
(3) cracked tooth;
(4) split tooth; and
(5) vertical root fracture

 Incidence of the tooth fracture

 Craze lines
Step 1: where is crack/ fracture Facial or lingual in enamel only
located? - Also common on marginal
ridges
Step 2: Are these separable Non-separable (Incomplete
segments? fracture)

Step 3: What type of crack/ fracture Craze line

is it?

Step 4: How to treat? No treatment or esthetic

treatment only

Step 1: where is crack/
fracture located?
Step 2: Are these separable
segments?
Step 3: What type of crack/
fracture is it?
Step 4: How to treat?
Cuspal fracture
F-L and M-D in enamel
and dentin of the crown
and root
Non-separable Separable (Complete
(Incomplete fracture) fracture)
Incomplete Cuspal Complete cuspal fracture
fracture (Cuspal crack)
- Retain or remove cusp - Remove cusp
- RCT if pulp is exposed - RCT if pulp is exposed
- Cuspally reinforced - Cuspally reinforced
restoration restoration
 Incidence
Separable Non-separable
extensive deep
Subjective Objective
Etiopathogenesis Removal of the cusp
findings
interproximal
Cusp need caries
not be removed
Followed by placement of - Cuspallytests or
reinforced
3/4th crown/ onlay/ full a subsequent
restoration large Class II
is indicated
Clinical features coverage crown restoration
(crown/ onlay)

Root canal treatment: if

Diagnosis Radiographic
pulp is exposedOther
findings
Unsupported findings
Remove fracture segment
Treatment & and than
using a bur rather
Prognosis Undermined tooth structure
extraction forcep

Prevention
 Crack tooth to split tooth
Step 1: where is crack/ M-D in enamel and dentin
fracture located? of the crown only or
crown and root
Step 2: Are these separable Non-separable Separable (Complete
segments? (Incomplete fracture) fracture)

Step 3: What type of crack/ Crack tooth Split tooth

fracture is it?

Step 4: How to treat? - RCT if pulp is exposed - Extraction followed by

- Cuspally reinforced FPD or Implant
restoration
- Extraction
 Incidence
(Rivera et al) Study Conclusion

Etiopathogenesis Tan et al. Subjective N=50 of root-filled cracked

Objective
findings teeth with a diagnosis of
tests
irreversible pulpitis and
Clinical features determined a 2-year survival
rateStaining
of 85.5%.with methylene
Krell & Rivera 127 patients blue dye
with teeth
Diagnosis diagnosed with reversible
Other Radiographic
pulpitisWedging
that hadforces to
a cracked
findings findings
Treatment & differentiate
tooth placementseparable or
of a crown
Prognosis non-separable
restoration withoutfracture
performing
Transillumination root canal treatment
Surgical
- Within microscope
6 months: 20%
Prevention
irreversible pulpitis or necrosis
 MANAGEMENT
OF
FRACTURED TOOTH

Dr Urvashi Sodvadiya
Flow Chart
• Introduction
• Classification of tooth fracture
• Longitudinal tooth fracture
• Craze lines
• Cuspal fracture
• Crack tooth to split tooth
• Vertical fracture
Risk factors
Diagnosis
Management
• Transverse tooth fracture
• Horizontal root fracture
Classification of horizontal fracture
Diagnosis
 Treatment based on location
Spliting
Types of healing
Factors influences healing and prognosis
IATD Guidelines
• Enamel fracture
• Enamel-dentin fracture
• Enamel-dentin-pulp fracture
• Crown-root fracture without pulpal involvement
• Crown-root fracture with pulpal involvement
• Conclusion
• References
 Split tooth
Incidence

Etiopathogenesis

Extraction (If fracture is deep apically)

Clinical features
or

Diagnosis Remove the fractured segment and perform

crown lengthening or orthodontic extrusion
Treatment &
Prognosis

Prevention
 Vertical fracture
Step 1: where is crack/ F-L in root only
fracture located?

Step 2: Are these separable Non-separable Separable (Complete

segments? “Third most common”
(Incomplete
causefracture) fracture)
of tooth loss (Kishen A; 2006)
- Involves
Prevalence: one root
2%-20% surface
(Chang - Involves both root
E et al;2016)
Incidence: 1.4 times higher for men (Chan CP surfaces
et al; 1999)
No significant
Step 3: What type of crack/ difference
Incomplete (Seo DG et al;Complete
vertical 2012) vertical fracture
fracture is it? fracture

Step 4: How to treat? - Extraction / removal of involved root followed by

prosthesis
 Related to tooth
Related to Dentist

- Post endodontic restoration

- Type of endodontic
treatment (Karygianni L et al; 2014)
- Immature teeth with - Reduced mechanical
incomplete root formation properties of tooth structure
- Endodontic access cavity - Tooth form (Lertchirakarn V et
al; 2003)
preparation (Seo et al; 2012)
- Anatomical location
- Root canal preparation
- Changes in dentinal
- Root canal obturation
Microstructure
- Post space preparation
- Coronal restoration
- ETT as abutment Risk Factors
 Diagnosis

Patient’s symptoms Location of Sinus tract

Periodontal probing Radiograph Surgical exploration

Conventional
Radiography
 Abscess may
“come and go”

Periodontal abscess At the time of completion of

RCT

After 6 years
Meister Jr F, Lommel TJ, Gerstein H. Diagnosis and possible causes of vertical root fractures. Oral Surgery, Oral Medicine, Oral Pathology. 1980 Mar 1;49(3):243-53
.
 Management

 Extraction

 Hemisection

 Sealing the Gap of Vertical Root Fracture through the Root Canal

 Replantation after binding the fracture fragments using adhesive

resin
 Hemisection

2 years follow up

Agrawal VS, Kapoor S, Shah NC. An innovative approach for treating vertically fractured mandibular molar-hemisection with socket preservation. Journal of Interdisciplinary Dentistry. 2012 May
1;2(2):141
 Sealing the Gap of Vertical Root Fracture through the Root Canal

Sugaya T, Natatsuka M, Motoki Y, Inoue K, Tanaka S, Miyaji H. Sealing the gap of vertical root fracture through the root canal. Dentistry. 2016;6(354):2161-1122.
 Replantation after
binding the fracture
fragments using adhesive
resin

Alsani A, Balhaddad A, Nazir MA. Vertical root

fracture: a case report and review of the literature.
Giornale italiano di endodonzia. 2017 Jun
1;31(1):21-8.
Transverse fracture
 Horizontal root fracture
(Transverse/ Intraalveolar fracture)

Prevalence: 0.5%-7.0%
Commonly affected region: Maxillary front region (Andersen FM et al; 2007)
Commonly affected part of the root: middle third 57% and apical third 34%
(Hovland EJ; 1992)
“Highest chances of preservation of pulp vitality” (Mata E et al; 1985)
Andreasen FM,
Mata
Andreasen
E, Gross MA,
JO, Cvek
KorenM.LZ.
Root
Divergent
fractures.
types
In: of
Textbook
repair associated
and Color with
Atlasroot
of Traumatic
fracturesInjuries
in maxillary
to Teeth.
incisors.
Andreasen
Endod Dent
FM, Andreasen
Traumatol JO,
1985;
eds.
1:Copenhagen:
150–153
Blackwell Publishing Ltd, 2007: pp337– 371.
Hovland EJ. Horizontal root fractures: treatment repair. Dent Clin North Am 1992; 36: 509–525
 Classification
of
Horizontal root fracture

Feiglin B. The management of horizontal root fractures – a treatment dilemma. Ann R Aust Coll Dent Surg 1981; 7: 81.
 Diagnosis

 History

 Clinical examination

 Pulpal status

 Radiographic examination
 Treatment
APICAL

Cvek M, Mejare I, Andreasen JO: Conservative endodontic treatment of teeth fractured in the middle or apical part of the root, Dent Traumatol 20:261-269,
 Treatment
MIDDLE
 Treatment
CORONAL

Cvek M, Mejare I, Andreasen JO: Healing and prognosis of teeth with intra-alveolar fractures involving the cervical part of the root, Dent Traumatol 18:57-65,
Splinting

Küçükyılmaz E, Botsalı MS, Keser G. Treatments of horizontal root fractures: Four case reports.
 Treatment of horizontal root fracture
associated root resorption

Pasha S, Valli SK, Raza MZ. Nonsurgical management of horizontal root fracture associated external root resorption and internal root resorption. Indian Journal of Dental
Sciences. 2016 Jul 1;8(3):150.
 22 year old male
Reported after 3 6 months
weeks of accident follow up

Kunhappan S, Patil S, Agrawal P. Conservative management of displaced horizontal root fracture. Journal of the International Clinical Dental Research Organization. 2011
Jan 1;3(1):48.
 Healing in root fracture
(Andreasen and Hjorting-Hansen)

Andreasen JO, Hjorting-Hansen E. Intraalveolar root fractures: Radiographic and histologic study of 50 cases. J Oral Surg 1967;25:414-26.
 “Healing by interposition of bone and connective tissue”

Rothom R, Chuveera P. Differences in Healing of a Horizontal Root Fracture as Seen on Conventional Periapical Radiography and Cone-Beam Computed Tomography.
Case reports in dentistry. 2017;2017.
 “Healing by calcification”

After 2 years

A 16-year-old male patient was referred to the Department of Clinics with pain in the region of the upper incisors.
Martos J, Amaral LP, Silveira LF, Damian MF, Xavier CB, Lorenzi A. Clinical management of horizontal root fractures aided by the use of cone-beam computed
tomography. Giornale italiano di endodonzia. 2017 Nov 1;31(2):102-8.
 “Healing by interposition of connective tissue”

After 24 months

Because of a motorcycle
accident, a 39-year-old female
presented with facial trauma 10
days before

Martos J, Amaral LP, Silveira LF, Damian MF, Xavier CB, Lorenzi A. Clinical management of horizontal root fractures aided by the use of cone-beam computed
tomography. Giornale italiano di endodonzia. 2017 Nov 1;31(2):102-8.
Indicators of favourable
outcomes
 Asymptomatic status
 Positive response to pulp testing
 Continuing root development in
immature teeth
 Signs of repair between fractured
segments
 Absence of apical periodontitis
Factors that influence
healing and prognosis
 Position and mobility of coronal
segment after trauma
 Status of the pulp
 Position of the fracture line
 Treatment time
 Communication with the oral
environment
 Age
 Synopsis of effect of pre-injury factors on root fracture healing

Andreasen JO, Andreasen FM, Mejàre I, Cvek M. Healing of 400 intra‐alveolar root fractures. 1. Effect of pre‐injury and injury factors such as sex, age, stage of root
development, fracture type, location of fracture and severity of dislocation. Dental Traumatology. 2004 Aug;20(4):192-202.
 “IADT Guidelines (2012) ”
DiAngelis AJ, Andreasen JO, Ebeleseder KA, Kenny DJ, Trope M, Sigurdsson A, Andersson L, Bourguignon C, Flores MT, Hicks ML, Lenzi AR. International Association of Dental Traumatology
guidelines for the management of traumatic dental injuries: 1. Fractures and luxations of permanent teeth. Dental Traumatology. 2012 Feb;28(1):2-12.
 Ellis and Davey’s
Classification of tooth fracture (1970)
 Enamel fracture
Type of fracture Outcomefindings
Radiographic
Clinical
Treatment findings
Enamel fracture ••Favourable:
AIfcomplete
Enamel theloss
toothisfracture
visible of istheavailable,
fragment enamel it
••• Radiographs
Asymptomatic
Loss of enamel.
can be bonded Nothe
to visible
recommended: toothsign of
• Positivedentin
response to and
pulp eccentric
testing
•• Continuing
exposed
periapical,
Contouringocclusal,
or restoration with
root development in
• Not
exposures.tender.
composite If tenderness
They are recommendedis observed,
in
immature teethresin depending on the
evaluate
order extent
• Continue
the
to rule
and tooth
out theforpossible
location
to next
aofpossible
evaluation
presence
the fracture
ofluxation
a root or root fracture
fracture
Unfavourable: injuryinjury
or a luxation
••• Radiograph
Normal mobility
Symptomatic of lip or cheek
•• Negative
Sensibility
lacerations topulp
search
response test: usually
to for
pulp tooth positive
testing
• Signs of apical
fragments periodontitis
or foreign materials
• No continuing root development in
immature teeth
• Endodontic therapy appropriate for stage
of root development is indicated
DiAngelis AJ, Andreasen JO, Ebeleseder KA, Kenny DJ, Trope M, Sigurdsson A, Andersson L, Bourguignon C, Flores MT, Hicks ML, Lenzi AR. International Association of Dental Traumatology
guidelines for the management of traumatic dental injuries: 1. Fractures and luxations of permanent teeth. Dental Traumatology. 2012 Feb;28(1):2-12.
 Fragment reattachment

Martos J, Pinto KV, Miguelis TM, Xavier CB. Management of an uncomplicated crown fracture by reattaching the fractured fragment—Case report. Dental Traumatology.
 “Comparative evaluation of
fracture resistance using two
rehydration protocols for
fragment reattachment in
uncomplicated crown fractures”

Madhubala A, Tewari N, Mathur VP, Bansal K. Comparative evaluation of fracture resistance using two rehydration protocols for fragment reattachment in uncomplicated crown fractures. Dental
 Enamel-Dentin fracture
Type of fracture Radiographic
Outcome
Treatment
Clinical findings findings
Enamel–dentin fracture •A fracture reattachment:
-Favourable:
Fragment
Enamel–dentin confined
loss istovisible
enamel and
if available
-•dentin
Asymptomatic
Radiographs
Provisional
with loss recommended:
restoration: Glass inomer
of tooth structure, but
•not
cementPositive
periapical, response
exposing occlusal, to pulp
the pulp testing
and eccentric
•• Continuing
Percussion
-exposure
Final root
test:development
restoration:
to rule not
out tender. in
composite
tooth Ifresin
immature
-displacement teethor dentin
If the exposed possible isevaluate
within 0.5
presence
tenderness is observed, theof
• Continue
mm of the to
pulpnext(pink,
evaluation
no bleeding):
root fracture
tooth for possible luxation or root
Unfavourable:
•fracture
Radiograph
place calcium
injury of lip or cheek
hydroxide base and
• Symptomatic
•• Negative
Normal
cover withmobility
lacerations atomaterial
search
response such
to for
pulp as a glass
tooth
testing
•• Signs
Sensibility
ionomer
fragments pulp
or foreign
of apical test: usually positive
materials
periodontitis
• No continuing root development in
immature teeth
• Endodontic therapy appropriate for stage
of root development is indicated
DiAngelis AJ, Andreasen JO, Ebeleseder KA, Kenny DJ, Trope M, Sigurdsson A, Andersson L, Bourguignon C, Flores MT, Hicks ML, Lenzi AR. International Association of Dental Traumatology
guidelines for the management of traumatic dental injuries: 1. Fractures and luxations of permanent teeth. Dental Traumatology. 2012 Feb;28(1):2-12.
 Enamel-Dentin-Pulp fracture
Type of fracture Radiographic
Treatment
Clinical findings
findings
Enamel–dentin pulp -Enamel–dentin
Immature
A fracture teeth:
losspulp
involving capping/
enamel
visible and
fracture •dentin
Radiographs
partial lossrecommended:
pulpotomy
with of tooth structure and
-periapical,
Matureofteeth:
exposure RCTand
the pulp.
occlusal, recommended
eccentric
• Normal
-exposures
Fragmentmobility
to reattachment:
rule out tooth if available
• Percussion test:
displacement not tender.
or possible If
presence of
tenderness
root fractureis observed, evaluate for
•possible
Radiograph of lip
luxation oror cheek
root fracture
injury
lacerations to search for tooth
• Exposed or
fragments pulp sensitive
foreign to stimuli
materials

DiAngelis AJ, Andreasen JO, Ebeleseder KA, Kenny DJ, Trope M, Sigurdsson A, Andersson L, Bourguignon C, Flores MT, Hicks ML, Lenzi AR. International Association of Dental Traumatology
guidelines for the management of traumatic dental injuries: 1. Fractures and luxations of permanent teeth. Dental Traumatology. 2012 Feb;28(1):2-12.
 Enamel-Dentin-Pulp fracture

PREOPERATIVE PHOTOGRAPH

PREOPERATIVE PHOTOGRAPH
 PRESERVATIVE MANAGEMENT OF TRAUMATIZED
MAXILLARY CENTRAL INCISOR USING FIBER REINFORCED
COMPOSITE

PRE-OPERATIVE PHOTOGRAPHS- FRACTURE WRT 11 EXTENDING INTO

CERVICAL REGION PALATALLY

PRE-OPERATIVE RADIOGRAPH
STABILIZATION OF THE FRACTURED FRAGMENT USING FLOWABLE COMPOSITE

REHABILITATION OF 11 USING FIBER POST

 Crown root fracture without pulp exposure
Type of fracture Radiographic findings
Clinical findings
Ttreatment
Enamel–dentin pulp • AsApical
•an emergency
Crown treatment:
extension
fracture of temporary
fracture
extending usually
below
fracture stabilization
not visible
gingival margin
• Non-emergency
•- Radiographs recommended:
treatment:
Percussion test: tender fragment removal
only
• Coronal fragment
periapical, occlusal,mobile
and eccentric
Followed by: to pulp
• Sensibility
exposures testtooth
rule out usually positive
- subsequent
displacement restoration of the
or possible
for apical fragment apicalof
presence
fragment exposed above the gingival level
root fracture
- subsequent endodontic treatment and
restoration with a post-retained crown.
- Preceded by a gingivectomy, and
sometimes ostectomy with osteoplasty
Orthodontic extrusion of apical fragment
- Extraction: inevitable in crown–root fractures
with a severe apical extension
DiAngelis AJ, Andreasen JO, Ebeleseder KA, Kenny DJ, Trope M, Sigurdsson A, Andersson L, Bourguignon C, Flores MT, Hicks ML, Lenzi AR. International Association of Dental Traumatology
guidelines for the management of traumatic dental injuries: 1. Fractures and luxations of permanent teeth. Dental Traumatology. 2012 Feb;28(1):2-12.
 Crown root fracture with pulp exposure
Type of fracture Radiographic
Treatment findings
Clinical findings
•- Apical
Emergency extension
Crown root fracture Non-emergency
A fracture of fracture
treatment: enamel,usually
treatment
involving dentin,
not
and visible
with pulp exposure alternatives:
cementum and exposing the pulp
•- Radiographs
-temporary
Percussion recommended:
stabilization
test: tenderof the loose
-segment
periapical, occlusal
Removalfragment
- Coronal radiograph
of the coronal
mobilefragment
Tooth
withwith open apices:
subsequent endodontic
- preserveand
treatment pulp vitality bywith
restoration a partial
a
pulpotomy
post-retained crown.
- Orthodontic extrusion of apical
Completely
fragment formed teeth:
- In youngispatient:
- Extraction partial
inevitable in very deep
pulpotomy
crown-root fractures
- In older patient: Root canal
treatment
DiAngelis AJ, Andreasen JO, Ebeleseder KA, Kenny DJ, Trope M, Sigurdsson A, Andersson L, Bourguignon C, Flores MT, Hicks ML, Lenzi AR. International Association of Dental Traumatology
guidelines for the management of traumatic dental injuries: 1. Fractures and luxations of permanent teeth. Dental Traumatology. 2012 Feb;28(1):2-12.
 MANAGING SUBGINGIVAL FRACTURE BY MULTI-
DISCIPLINARY APPROACH

CLASS VII FRACTURE OF 21 AND 22 DUE TO TRAUMA REMOVAL OF THE FRACTURED FRAGMENT

PRE-OPERATIVE RADIOGRAPH SUBGINGIVAL EXTENSION OF THE FRACTURE LINE IN THE PALATAL REGION
POST SPACE PREPARATION WRT FABRICATION OF PROVISIONAL
21 AND 22 RESTORATION

CEMENTATION OF PROVISIONAL RESTORATION

FABRICATION OF J HOOK USING 1 MM WIRE AND CEMENTATION INTO THE 45 DAYS AFTER ORTHODONTIC EXTRUSION
CANAL USING ZINC PHOSPHATE CEMENT

ACTIVATION USING ELASTICS PLACEMENT OF FIBER POST AND CORE BUILD UP WITH RESPECT TO 21
Conclusion
 References
 DiAngelis AJ, Andreasen JO, Ebeleseder KA, Kenny DJ, Trope M, Sigurdsson A, Andersson
L, Bourguignon C, Flores MT, Hicks ML, Lenzi AR. International Association of Dental
Traumatology guidelines for the management of traumatic dental injuries: 1. Fractures and
luxations of permanent teeth. Dental Traumatology. 2012 Feb;28(1):2-12.
 Bader JD, Martin JA, Shugars DA. Preliminary estimates of the incidence and consequences
of tooth fracture. J Am Dent Assoc 1995: 126: 1650–1654.
 Andreasen JO, Andreasen FM, Mejàre I, Cvek M. Healing of 400 intra‐alveolar root fractures.
1. Effect of pre‐injury and injury factors such as sex, age, stage of root development, fracture
type, location of fracture and severity of dislocation. Dental Traumatology. 2004
Aug;20(4):192-202.
 Küçükyılmaz E, Botsalı MS, Keser G. Treatments of horizontal root fractures: Four case
reports.
 Cvek M, Mejare I, Andreasen JO: Healing and prognosis of teeth with intra-alveolar fractures
involving the cervical part of the root, Dent Traumatol 18:57-65, 2002.
 References
 Feiglin B. The management of horizontal root fractures – a treatment dilemma. Ann R Aust
Coll Dent Surg 1981; 7: 81.
 Andreasen FM, Andreasen JO, Cvek M. Root fractures. In: Textbook and Color Atlas of
Traumatic Injuries to Teeth. Andreasen FM, Andreasen JO, eds. Copenhagen: Blackwell
Publishing Ltd, 2007: pp337– 371.
 Hovland EJ. Horizontal root fractures: treatment repair. Dent Clin North Am 1992; 36: 509–
525
 Sugaya T, Natatsuka M, Motoki Y, Inoue K, Tanaka S, Miyaji H. Sealing the gap of vertical
root fracture through the root canal. Dentistry. 2016;6(354):2161-1122.
 Agrawal VS, Kapoor S, Shah NC. An innovative approach for treating vertically fractured
mandibular molar-hemisection with socket preservation. Journal of Interdisciplinary Dentistry.
2012 May 1;2(2):141
 Meister Jr F, Lommel TJ, Gerstein H. Diagnosis and possible causes of vertical root fractures.
Oral Surgery, Oral Medicine, Oral Pathology. 1980 Mar 1;49(3):243-53
 Pasha S, Valli SK, Raza MZ. Nonsurgical management of horizontal root fracture associated
external root resorption and internal root resorption. Indian Journal of Dental Sciences. 2016
Jul 1;8(3):150.
 References
 Alsani A, Balhaddad A, Nazir MA. Vertical root fracture: a case report and review of the
literature. Giornale italiano di endodonzia. 2017 Jun 1;31(1):21-8.
 Mata E, Gross MA, Koren LZ. Divergent types of repair associated with root fractures in
maxillary incisors. Endod Dent Traumatol 1985; 1: 150–153
 Martos J, Amaral LP, Silveira LF, Damian MF, Xavier CB, Lorenzi A. Clinical management of
horizontal root fractures aided by the use of cone-beam computed tomography. Giornale
italiano di endodonzia. 2017 Nov 1;31(2):102-8.
 Rothom R, Chuveera P. Differences in Healing of a Horizontal Root Fracture as Seen on
Conventional Periapical Radiography and Cone-Beam Computed Tomography. Case reports in
dentistry. 2017;2017.
 Andreasen JO, Hjorting-Hansen E. Intraalveolar root fractures: Radiographic and histologic
study of 50 cases. J Oral Surg 1967;25:414-26.
 Kunhappan S, Patil S, Agrawal P. Conservative management of displaced horizontal root
fracture. Journal of the International Clinical Dental Research Organization. 2011 Jan
1;3(1):48.
 Küçükyılmaz E, Botsalı MS, Keser G. Treatments of horizontal root fractures: Four case
reports.
Thank you!