Root fractures comprise approximately 0.5–7% of all traumatic injuries to the permanent dentition and frequently are diagnosed after trauma to the face and mouth.
Horizontal fractures are most frequent in the middle third of the root and rare in the apical third, they occur more often in the maxillary central incisors of male patients. According to Andreasen, the healing process of horizontal root fractures depends on several variables, such as the age of the patient, the mobility of the coronal fragment, the location of the root fracture and the stage of root formation.
Traumatic dental injuries prognosis depends on the time elapsed between the traumatic event and the beginning of the treatment. For this reason, the correct diagnosis is decisive in order to influence the therapy and therefore the prognosis.
Diagnosis of root fracture is generally based on intra-oral signs and symptoms and confirmed by intra-oral radiograph. But… are we sure that periapical radiographs give us a correct view of what happened?
Conventional radiographs can be helpful for the diagnosis only when the x-ray beam is parallel to the plane of the fracture, but this is not always possible! There is a significant risk of misdiagnosing the location (or the presence!) of a root fracture on an anterior tooth when intra-oral radiograph is used.
Currently, 3D images using CT methods have been developed to overcome the disadvantages associated with the conventional radiographic methods. 3D visualization of the presence, location, extent and direction of a root fracture allows the clinician an accurate diagnosis and thus the appropriate course of treatment.
Cone beam computed tomography should be considered as the most reliable imaging choice for the diagnosis of horizontal root fracture. Despite the possible advantages of this method, it should be borne in mind that CBCT still has a higher radiation dose and it should not be prescribed until a precise clinical examination has been conducted and it should be recommended when the diagnostic information improve the treatment results.
Remember that the first diagnosis is made by a clinician who can detect clinical sign and symptoms!
Editor in chief