Fractured root - Is extraction the only remedy?

My son (age 11) injured one of his front teeth several years ago and we've had continuous problems with it, including abscessing at the root. He's had two root canals and, just recently, an apioectomy. Unfortunately, the endodontist discovered a split root. We've been told that the only remedy now is extraction. Do you agree?

Question:

Dear Debbie,

The roots of teeth can fracture in two basic ways, either horizontally or vertically. If the root is fractured horizontally, the prognosis for the tooth is somewhat dependent upon where the fracture is located. The degree of separation between the fragments also plays a role in determining the prognosis. Horizontal fractures in the apical one third (portion of the root closest to the root tip) generally have the best prognosis. Horizontal fractures in the middle third of the root have a less favorable prognosis than ones in the apical third. Horizontal fractures in the coronal one third (portion of the root furthest from the root tip) have the least favorable prognosis. If the fragments are in close approximation, however, the prognosis is more favorable.

Vertical fractures in the root are relatively uncommon. They cannot be successfully treated with root canal therapy. Unfortunately, the only option for a tooth with a vertical root fracture is extraction.

Before having the tooth extracted, you and your dentist should discuss treatment options (i.e. some type of bridge, implant, or removable partial dentures). Temporary measures for replacing the missing tooth while the healing process occurs should also be discussed. A common temporary restoration is a stayplate, or "flipper". A stayplate is similar to a removable partial denture, except there is no metal framework. The stayplate can be fabricated prior to the appointment for the extraction; then, the day of the extraction, the stayplate can be delivered to replace the missing tooth.

If an implant is an option you would seriously consider, the stayplate may need to be adjusted or even remade as your son grows. An implant should not be placed until your son is much older (probably around age 18). It is important to wait until his bones have stopped growing. In addition, these years will give the bone a chance to increase its density, which would increase the success of the implant.

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