The Horizontal Root Fractures. Diagnosis, Clinical Management and Three-Year Follow-Up

Roberto Lo Giudice1, Angelo Lizio2, Gabriele Cervino2, Nicita Fabiana, Puleio Francesco, Pietro Ausiello3, Marco Cicciù2, *
1 Department of Clinical and Experimental Medicine, Messina University, Messina, Italy
2 Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Messina University, AOU Policlinico “G. Martino” Via C. Valeria 98100, Messina, Italy
3 Department of Neurosciences, Reproductive and Odontostomatological Sciences, Naples Federico II University, Naples, Italy

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© 2018 Lo Giudice et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: ( This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Messina University, AOU Policlinico “G. Martino” Via C. Valeria 98100, Messina, Italy; E-mail:



The aim of this retrospective analysis is to describe and to evaluate the middle third horizontal root fractures, long term clinical management results and to estimate the effect of treatments factors upon healing and survival rate.


Our clinical study included 42 patients presenting a middle third horizontal root fracture in permanent dentition. For each patient at t0 the parameters recorded were: diastasis, mobility, sensibility, periodontal inflammation, pulpal pathology, associated fracture and dislocation of the coronal fragment. The follow-up was performed after 6 (t1), 12 (t2) and 36 (t3) months after the trauma, both clinically and radiologically. Clinical examination, vitality tests and a radiological evaluation (periapical x-ray) were performed.


At t0 it was observed: diastasis (14, 3%), mobility (28, 6%), thermal sensibility (61, 9%), periodontal inflammation (4, 8%), pulpal pathology (38, 1%) and dislocation of the coronal fragment (47, 6%) of the patients. The treatment plan started with the coronal fragment repositioning and the blockage (splint) with the adjacent teeth in 47, 6% of cases.

A root canal treatment was performed at t0 in 52,4% of the fractured teeth. Statistical analysis showed the highest level of significance between pulpal lesions (t0) and associated fractures. The mobility, sensibility and pulpar lesions parameters, showed a reduction in relation to the follow up timing, with a main variation remarkably evident between t0 and t1. The ratio between observation time and the presence of diastasis was statistically significant.


The analysis of the clinical results exhibits the high success rate of a conservative approach in the treatment of teeth fractured in the middle third of the root.

Keywords: Dental trauma, Root fracture, Splints, Periodontal inflammation, Pulpal pathology, Alveolar bone.