Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada; Dental Trauma Center, Iranian Academic Center for Education, Culture, and Research, Mashhad, Iran.
Faculty of Dental Medicine and Oral Health Sciences, McGill University, Montreal, Quebec, Canada.
J Endod. 2024 May;50(5):579-589. doi: 10.1016/j.joen.2024.02.002. Epub 2024 Feb 13.
Horizontal root fracture (HRF) is a complex traumatic dental injury that affects the pulp, dentin, cementum, and periodontal ligament. This retrospective cohort study evaluated treatment outcomes in permanent teeth with HRF.
We analyzed clinical and radiographic data from a dental trauma center (2006-2022). Permanent teeth with HRF with a follow up of ≥12 weeks were considered for outcome assessment (defined as clinical normalcy and radiographic healing at the fracture line). Prognostic factors were identified through multivariable logistic regression analyses (P value ≤ .05).
125 teeth from 103 patients were included. After a median follow-up of 79 weeks, the overall favorable outcome was 92%. This includes teeth that received emergency splinting/repositioning at baseline (62.2%) and those that received subsequent endodontic intervention for the coronal fragment (baseline: 85%; subsequent follow-ups: 91.8%). Being male and incomplete root development were both significantly associated with a better outcome of splinting/repositioning (OR = 2.58; 95% CI, 1.06-6.24 and OR = 4.37; 95% CI, 1.16-16.41, respectively) and a reduced likelihood of requiring endodontic treatment (OR = 0.44; 95% CI, 0.20-0.96 and OR = 0.24; 95% CI, 0.08-0.76, respectively). Treatment delays surpassing one week were significantly associated with an increased likelihood of requiring endodontic treatment compared to timely presentations within 24 hours (OR = 3.06; 95% CI, 1.07-8.77; P value < .05).
With timely diagnosis and treatment, and close monitoring, HRF cases can achieve a 92% favorable outcome. Male sex and incomplete root development correlate with improved baseline outcomes and a reduced need for endodontic treatment. Conversely, delayed presentation increases the likelihood of requiring endodontic intervention.
水平根折（HRF）是一种复杂的外伤性牙损伤，影响牙髓、牙本质、牙骨质和牙周膜。本回顾性队列研究评估了 HRF 恒牙的治疗结果。
我们分析了一家牙科创伤中心（2006-2022 年）的临床和影像学数据。对随访时间≥12 周的 HRF 恒牙进行疗效评估（定义为临床正常和骨折线处的影像学愈合）。通过多变量逻辑回归分析确定预后因素（P 值≤.05）。
纳入 103 名患者的 125 颗牙。中位随访 79 周后，整体良好结局率为 92%。这包括基线时接受急症夹板复位治疗的牙齿（62.2%）和随后对冠段进行根管治疗的牙齿（基线：85%；后续随访：91.8%）。男性和不完全根发育均与夹板复位的更好结局显著相关（OR=2.58；95%CI，1.06-6.24 和 OR=4.37；95%CI，1.16-16.41），并且降低了需要根管治疗的可能性（OR=0.44；95%CI，0.20-0.96 和 OR=0.24；95%CI，0.08-0.76）。与在 24 小时内及时就诊相比，治疗延迟超过一周与更有可能需要根管治疗显著相关（OR=3.06；95%CI，1.07-8.77；P 值<.05）。
及时诊断和治疗，密切监测，HRF 病例可获得 92%的良好结局。男性和不完全根发育与基线时的改善结局和减少根管治疗的需求相关。相反，延迟就诊增加了需要根管介入的可能性。
