Pulp necrosis and root injuries
One of the consequences of inflammation is necrosis of the pulp in the coronal fragment. In this case, the clinical crown loses its natural luster, acquiring a gray, gray-yellow, or brown tint. Treatment in such cases involves standard endodontic intervention.
In a middle-third root fracture with fragment displacement, extirpation of both necrotic and vital pulp is performed, followed by post stabilization of the fragments. A crucial condition is the tight apposition of the fragments to each other. If sealing material (phosphate cement) accidentally enters the gap between them, it will provoke chronic periodontitis.
Fragment stabilization technique and apical fractures
The post fixation technique includes selecting an instrument according to the canal diameter, introducing it through the coronal into the apical fragment, and fixing it with phosphate cement. After the material sets, the tooth must be taken out of occlusion.
In a fracture of the apical third of the root, the pulp is removed only from the coronal part, and the canal is filled up to the fracture line, applying a splinting device if tooth mobility is present. If the pulp of the apical fragment remains vital, it is left in place; if inflammation develops, root-end resection is performed.
Endodontic treatment errors and regeneration
During endodontic procedures, serious errors and complications may occur:
- Perforation of the root canal wall in the apical third by an instrument;
- Incorrect choice of filling material (sealer/filler);
- Underextension of the root canal filling short of the physiological apex;
- Excessive extrusion of material beyond the apical foramen into the periodontium.
Healing (reparative osteogenesis) in the fracture gap area of non-vital teeth occurs through appositional growth from the alveolar walls, resulting in the replacement of the periodontium with compact coarse-fibered bone tissue.
Post on cement — the canal is dry, and the tooth needs rest (out of occlusion).
Class and exam questions
What are the clinical signs of coronal pulp necrosis?
The clinical crown loses its natural luster and acquires a gray, gray-yellow, or brown tint.
What happens when phosphate cement enters the gap between root fragments?
This leads to the development of chronic inflammation in the periodontium.
In which cases is a tooth with a root fracture indicated for extraction?
The tooth is extracted when it is impossible to reposition the fragments properly, in case of a comminuted fracture, or fracture of the alveolar wall.
What else to study on this topic
- Definitions of endodontics and the endodont
- Elements of the pulpo-periapical complex
- Classification of pulpitis treatment methods
- Biological method of pulp vitality preservation
- Anatomical variations of root morphology
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