PMC5514331_01
(a) Initial intraoral photograph (June 2012) reveals tooth discoloration and slight extrusion of tooth 11. (b) Initial periapical radiograph of tooth 11 (June 2012) reveals a middle-third horizontal root fracture and underfilled root canal medication. Discontinuation of lamina dura with a radiolucent area is noticed on the mesial aspect of the fracture site (arrow). (c) The periapical radiograph one year after medication with Vitapex (June 2013) shows improved healing. A continuous lamina dura is seen on both sides of the fracture and the apical fragment appears within normal limits.
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Baseline intraoral photograph showing tooth discoloration (Figure 1(a)) and periapical radiographs (Figure 1(b)) were made prior to the initiation of definitive root canal treatment. A periapical radiograph showed resolution of the lateral radiolucency with a continuous lamina dura on both sides of the fracture and the apical fragment appeared to be within normal limits (Figure 1(c)).
Digital periapical radiographs. (a) Radiograph immediately after MTA obturation in coronal root fragment (June 2013) illustrates approximately 0.5 mm extruded MTA at the apical end of the coronal fragment and a suspected fracture line at the level of the cervical third on the distal aspect of the root (arrow). (b) Radiograph one year after MTA obturation (June 2014) reveals the ingression of bone into the diastasis from both mesial and distal aspects of the fracture, but it does not fill the central aspect of the diastasis (asterisks). The apical root fragment has a continuous lamina dura without apical radiolucency. ((c) and (d)) Radiographs two years after MTA obturation (June 2015) show complete healing at the diastasis (asterisks). A radiolucent line at the distal aspect of the cervical third of the root is still noticed (arrows).
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A digital periapical radiograph was made immediately after MTA obturation (Figure 2(a)). A periapical radiograph (Figure 2(b)) revealed the ingression of bone into the diastasis from both mesial and distal aspects of the fracture but did not fill its central aspect. At two-year follow-up (June, 2015), two periapical radiographs were made, one with the paralleling technique (Figure 2(c)) and the other with a decreased vertical angulation of the X-ray beam (Figure 2(d)). Hjorting-Hansen. However, another radiolucent line was noticed at the distal aspect of the cervical third (Figures 2(c) and 2(d)).
(a) Intraoral photograph after three cycles of internal bleaching of tooth 11 (July 2013) shows that the color was brighter than that of adjacent teeth (b) The incisal edge of tooth 11 was slightly reduced to minimize loading (arrow) (June 2015). The color of tooth 11 has not changed when compared with the tooth color immediately after MTA obturation and intracoronal bleaching performed two years previously.
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America, Alsip, IL, USA) as a cervical barrier and sodium perborate mixed with water as bleaching agent. After three cycles of bleaching, the color was brighter than that of adjacent teeth (Figure 3(a)). It was also noticed that the color of tooth 11 was stable when compared with the color after intracoronal bleaching which was performed two years previously (Figure 3(b)).
CBCT images (June 2015). (a) The sagittal CBCT slice of tooth 11 reveals a comminuted fracture on the labial aspect within the cervical third of the root (brace). A complete fracture line was found running obliquely from the middle third on the facial aspect through the cervical third on the palatal aspect (arrows). (b) The coronal CBCT slice reveals a horizontal root fracture in the middle third of the root without interposition of hard tissue (arrow).
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A sagittal CBCT slice (Figure 4(a)) revealed an unexpected comminuted fracture on the labial aspect within the cervical third of the root. A coronal CBCT slice (Figure 4(b)) revealed a horizontal root fracture in the middle third of the root without interposition of hard tissue at the diastasis.