Horizontal palatal root fracture in a vital upper first premolar.

Root fractures in non-root-filled teeth occur mostly in maxillary incisors because of trauma. Horizontal root fractures in posterior teeth are rare. This case report describes a horizontal fracture of the palatal root of an upper first premolar in which the pulp was vital. The patient had no symptoms and had no initial recollection of trauma. The dentition showed signs of bruxing and occlusal erosion. Cone-beam computed tomographic imaging identified the affected root. The literature revealed only 2 previous examples of horizontal root fractures in posterior teeth in which pulps remained vital. The possible roles of trauma and bruxing in the etiology are evaluated. A tooth with a fractured root may remain vital and symptomless. The etiology of the fracture can be difficult to establish in posterior teeth. Cone-beam computed tomographic imaging can be invaluable in identifying the fractured root. Pulp sensibility testing is critical before intervention.