Long-term bone preservation following mid-root fractures: a 12-year follow-up case report
This 12-year case report demonstrates that bilateral maxillary central incisors with mid-root fractures in a growing patient can be successfully retained long-term through individualized management involving delayed repositioning and endodontic treatment restricted solely to the necrotic coronal fragments, despite persistent localized bone rarefaction and slight mobility.
Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer
When a tooth is knocked or cracked, the immediate concern is often whether it can be saved. In the case of a horizontal root fracture, where the tooth breaks across its length like a snapped twig, the challenge is even greater. The break separates the visible part of the tooth from the root tip still buried in the jawbone. For a child still growing, this situation is particularly delicate. Removing the tooth might seem like a quick fix, but it leaves a gap in the jawbone that can shrink over time, making future replacements difficult. The goal, therefore, is to keep the natural tooth alive and in place as long as possible, allowing the jaw to grow around it until the child is an adult and ready for any final repairs. This requires a careful balance: the tooth must be stable enough to heal, but the treatment must not disturb the delicate tissues that hold it in the bone.
A team of researchers from the University of Brasília recently shared the story of one such tooth that survived a decade of growth and change. They followed a young girl who had suffered a bicycle accident at age ten, which resulted in a break right through the middle of the roots of her two front teeth. The top parts of these teeth were loose and shifted out of place, while the bottom parts remained firmly anchored in her jaw. Because the girl was still growing, the doctors could not simply pull the teeth out and replace them with implants, as the jaw would continue to change shape, leaving any artificial teeth misaligned. Instead, they chose a path of patience and precision, aiming to preserve the natural structure for as long as possible.
Eight months after the accident, the girl was referred to a specialized clinic. By then, the initial bandage holding her teeth together had not fixed the problem; the top pieces of the broken teeth were still loose and had not reconnected with the bottom pieces. The nerves inside the top parts of the teeth had died, a common result of such severe trauma, but the bottom parts remained healthy. The doctors decided to try a difficult maneuver: they gently loosened the top pieces of the teeth and pushed them back into their correct position against the bottom pieces. They then secured the teeth with a flexible wire splint to hold them steady while the body attempted to heal. Once the teeth were stable, the doctors treated only the top, dead sections of the roots. They cleaned out the damaged tissue and sealed it with a special material, leaving the healthy bottom sections completely untouched. This approach respected the body's natural ability to heal the living part of the tooth while removing the source of infection from the dead part.
Over the next twelve years, the girl grew into a young woman, and the two front teeth remained in her mouth. At the final check-up, the teeth were fully functional and looked natural. There were no signs of pain, and the girl had no complaints about how they felt or looked. X-rays showed that the bone around the teeth had held its shape, preserving the ridge of the jaw that would be essential for any future dental work. While the teeth were not perfectly rigid—they still had a slight wiggle, and there was a small area of thinner bone right where the break had occurred—this condition did not worsen over time. The teeth did not rot, the roots did not dissolve, and the surrounding bone did not collapse.
This long-term observation suggests that even when a tooth is broken in a way that seems difficult to fix, it can be kept for many years with the right care. The study indicates that for growing patients, it is often better to keep the natural tooth, even if it is not perfectly stable, rather than removing it. The doctors found that by treating only the damaged upper part of the tooth and leaving the healthy lower part alone, they could maintain the tooth through the critical years of facial growth. The presence of slight movement and minor bone changes did not prevent the teeth from serving their purpose. This case provides a clear example that with individualized planning and long-term monitoring, natural teeth can be preserved through complex injuries, delaying the need for more invasive solutions until the patient is fully grown.
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