Case of the day 5/13/2020: Vertical root fracture

Chief Complaint: Patient presented with pain on the lower right that kept him awake at night. "I had to take 800mg of Ibuprofen in order to get to sleep."

Clinical challenges:

• Radiographic exam showed mild Radiolucency around the tooth. Clinical exam showed isolated deep pocket of 7mm on the mesial buccal and mesial lingual. Percussion showed pain on the mesial of the tooth. No mobility was found.

• Diagnosis: Vertical root fracture.

  • After tooth extraction, a fracture radiated from the crown to the apical third of the tooth was found on the mesial side

Treatment:

• Atraumatic extraction, bone graft for future implant site. Osteointegration in the lower mandible would usually achieve in 3-4 months. In the office, we used 2 weeks, 2 months and 6 months follow up schedule.

• If patient wanted same day implant treatment, limited scaling and root planing on the lower right area was indicated for infection control.

  • Advantage of placing immediate implant placement is we could use the extracted tooth as the surgical guide for proper angulation of the implant.

  • Disadvantage of immediate implant placement would be infection control as the bone may not integrate well with minor infection in the area.

Evaluation:

• Atraumatic extraction usually lead to high success rate for osteointegration.

  • More extensive flap should be done to achieve more socket closure. In this case, I used figure and 1 interrupted suture to keep the membrane and allograft material in place.

  • PRF should be used for better healing.