Horizontal Root Fracture Treated by Intentional Replantation

Objectives: Treatment alternatives for root fractures depend on the fracture location and may contain treatment methods such as surgical or orthodontic extrusion, intentional replantation, periodontal surgery and extraction. Tooth with horizontal root fracture is usually needed extraction because of the difficulties of restoration. In this case report, we tried to treat a horizontal root fracture with combination of root restoration and intentional replantation.
Methods: A 55 years old female patient was referred to our clinic with advanced bone loss and a horizontal root fracture in the apical third of #31. Firstly, the phase I periodontal treatment was done and an appointment was given for surgical treatment. Under local anesthesia flap was elevated, the fractured segments of the teeth were extracted deliberately, then inflamed granulation tissues in root surface were removed using curettes. All fragments were soaked in physiological saline solution. Later, fragments of root were prepared with endodontic rotary instruments separately. Apical fragment’s canal filling was completed using gutta percha points and resin-based canal sealer. A fiber post was applied 3 mm away from apex, and remaining canal filling was removed as necessary for the placement of the post. After scaling and root planning , the extraction socket was gently curetted to remove debris. The tooth was replanted into its original position and stabilized to adjacent teeth by composite resin temporarily. One mounth later, free gingival graft and vestibuloplasty operation performed because of inadequate keratinized gingiva. Finally, following four month, intracoronal fiber splint applied permanently.
Results: The patient has been maintained for two years and there is no inflammation, attachment loss and complication in fracture area.
Conclusions: Generally, treatment of horizontal root fracture associated with advanced bone loss is resulted with extraction. But, in this case, we treated a horizontal root fracture with combination of root restoration and intentional replantation with any complication.