1) Trauma can occur with the most benign of events… this is a horizontal root fracture on the UR1 – obtained from an exuberant dog greeting (Australian Shepherd, not even that large of a dog)
2) Horizontal root fractures without symptoms or pathology need NO treatment – monitor per IADT/AAE guidelines but MUST be monitored.
***The apical segment will retain vitality and a “callus” should develop over time – as evidenced here on the 6m follow up scan/screenshot.
3) The more cervical/mobile a horizontal root fracture the greater the likelihood for negative sequelae – tooth may be lost, may develop necrosis more likely ALWAYS check occlusion on trauma cases… do any of the opposing teeth “hit”/contact the traumatized tooth – even in excursion? Check it, may need to be relieved. This is often overlooked.
4) Trauma has some predilection… in this case, very flared incisors are at higher risk/have a higher incidence of trauma (vs less flared/non-flared) – makes sense (among other risk factors)
5) After 6 – 9 months of monitoring, this pt is eager to start orthodontics (due to the flared teeth). I recently gave the green light to move forward, but being flared, this UR1 now will have to be moved >3 mms.
What do you all think is the likelihood that this apical segment will retain its vitality long-term post-ortho?
