Clinical considerations in the diagnosis and treatment of intra-alveolar root fractures.

Clinical and radiographic data collected from the 14 cases of intra-alveolar root-fractures, with follow-ups of one to 25 years, complement the findings of other investigators in that the prognosis of the endodontium is extremely favorable. A survey of reports indicate that 75% to 80% of the pulps in intra-alveolar root fractures recover with no need of any endodontic therapy. Furthermore, pulpal pain is seldom encountered. Although the electric pulp tester is considered an important diagnostic tool, it does have limitations. The significance of the negative response is questionable, especially in young, undeveloped teeth with open apexes. The failure to respond to the tester may be attributed to a high electrical impedance. As nociceptor nerve fibers are last to develop, failure to respond to the tester in young teeth may give a false signal of pulp necrosis. Traumatized vital teeth often give an initial negative response, as does a tooth with rapid dentin deposition. Fracture detection can be increased by taking X rays from more than one angle. Radiolucent areas occur in the region of the root fracture more readily than in the periapical region, in a ratio of 7 to 1. Variations in angulations can give false impressions of complete dentinal union and complete or incomplete calcification of the pulpal space and an illusion of a comminuted fracture. The latter seldom occur in intra-alveolar root fractures. Furthermore, the apparent obliteration of the canal and pulp chamber, as seen on the radiograph, does not imply total obliteration with calcific tissue. The root canals are most often patent and negotiable.(ABSTRACT TRUNCATED AT 250 WORDS)