Endopraktijk Ree

Cervical root fracture, 5-year follow-up

A 28-year old female fell from her bike during her holiday in France, and went to a hospital the next day. She was diagnosed with a complicated crown fracture of 21, luxation of 11, and a complicated cervical root fracture of 22. The original fragment that snapped off from 21 was re-attached.

The tooth with the cervical root fracture showed mobility 3, the dentist in France applied a splint, and recommended extraction of 22.
I saw her 1 week after the accident, and took a CBCT. It looked pretty hopeless.....

Since we had nothing to loose, I decided to remove the splint from 14-11 and 24 after another week, and to leave the splint on 21-22-23 in place for 3 months. All teeth tested vital, also 22.

We removed the splint after 3 months, and the tooth was still slightly mobile, but no pain anymore. I told the patient that she had to overcome her fear to use the tooth again in daily life, and that is what she did, step by step.
At the 1-year follow-up, the tooth didn't show any mobility and the patient was asymptomatic. All teeth tested vital.
Then she came with complaints after 2 years. I expected the worst scenario for the tooth with the cervical root fracture, but it was rock solid, tested vital and didn't show any probing depths. The pulp of 21 had become necrotic, and we did root canal treatment on this one.

At the 5 year follow-up, 22 was still stable, no complaints, fully asymptomatic.
A nice example of the healing capacity of an intra-alveolar root fracture in the cervical one-third of the root!

If you want to learn more about root and crows-root fractures, come to Deventer on May 30, where I will give a presentation on this topic, admission is free of charge!

See: https://www.colosseumdental.nl/academy/colosseum-dental-talks/ #/aanmeldformulier

Yesterday, I received my invite for the AAE 24 in LA. I will look back at more than 40 years of dental practice, at successful and failed cases. What have I learned over the years, and what would I have done differently today. Hope to see you in LA!

Intentional replantation with 180 degrees rotation using the Benex Extractor in a complicated dental trauma case⁣
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I want to share my first Benex Extractor case with you, I am really impressed with this great device! I was surprised how easy and controlled the procedure went. ⁣⁣
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This 20-year old student was referred to me 2 weeks after the accident took place. Cervical horizontal root fracture and vertical crown-root fracture of 11, and an oblique cervical crown root fracture of 12. The dentist applied the splint, and asked me to proceed with further treatment. ⁣⁣
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My plan was to preserve both roots, provided there were no additional fractures. I performed endo in 12 and 11, and after having removed the coronal part of 11, I isolated the remaining part of 11 with a rubberdam, did root canal treatment in 11, left space for the post, extracted the root of 11 with the Benex extractor, and replanted it with 180 degrees rotation, so the more deeply fractured palatal side was moved to the labial side, which has a lower crestal bone height. This allows maintenance of more tooth structure. The Benex is great for preserving soft and hard tissue. ⁣⁣
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Keeping a dry field is a challenge, as was the build-up after replantation. You should leave the screw in the root, otherwise you cannot keep the root in place, and then place wooden wedges for initial stabilization. But, I couldn’t remove the screw without compromising the position, so I decided make a bridge of composite. The bridge was very stable, and after that, I removed the screw, and it was rather easy to place the post and make a very simple and basic build-up. Because of the composite bridge, I couldn’t use a matrix. After I was done with the build-up, and after attaching the tooth to the splint, I removed the composite bridge to facilitate oral hygiene.⁣⁣
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12 can be extracted and rotated 180 after 4-5 weeks, as soon as 11 is stable enough. There will be enough grip to use a forceps.⁣⁣
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