Periodontal healing after bonding treatment of vertical root fracture

Abstract

Vertical root fractures lead to advanced periodontal breakdown with deep periodontal pockets and vertical bone defects. The purpose of this study is to evaluate clinically the periodontal healing of root fracture treatment using adhesive resin cement. In 22 patients, 23 teeth with vertical root fractures were treated with 4-META/MMA-TBB resin cement. Eleven fractured roots were bonded through the root canal (group A) and 12 fractured roots were bonded extra-orally and replanted (group B). All teeth were then restored with full cast crowns (n=20) or coping (n=3). Mean probing depth was 6.6 mm at pre-treatment and 4.4 mm 6 months after the treatment in group A, and 7.4 mm and 4.6 mm, respectively, in group B. Bleeding scores were 100% at pre-treatment and 36.4% after 6 months in group A and 91.7% and 8.3%, respectively in group B. Radiographic bone level was 56.8% at pretreatment and 59.1% after 6 months in group A, and 18.8% and 29.2%, respectively, in group B. Two roots of group A and three roots of group B were extracted due to refracture, deterioration of periodontal inflammation, mobility, and luxation. The remaining roots (n=18) presented no discomfort to the patients and there was no deterioration of periodontal conditions over a mean period of 33 months (range 14-74 months) in group A and over a mean period of 22 months (range 6-48 months) in group B. There was no ankylosed teeth nor was any root resorption detected. The results suggested that the treatment of vertical root fracture using 4-META/MMA-TBB resin has good prognostic possibilities.

Sealing the Gap of Vertical Root Fracture through the Root Canal

“…The results described in these reports suggest that bonding is effective for vertically fractured tooth roots. However, it has been pointed out that bonding through the root canal more likely results in insufficient improvement in periodontal pockets and bone defects than intentional replantation [5]. This might be explained by the presence of residual bacteria in the fracture gap, and the fact that it may be more difficult to completely bond the fracture gap when bonding through the root canal.…”

“…This resin was chosen because of reports stating that inflammation of periodontal ligament did not occur histopathologically after bonding of the fracture gap with Super Bond [11,13], and also because of a number of clinical reports [5][6][7][8][9] describing good outcomes when Super Bond was used to treat vertically fractured roots. Super Bond uses tri-n-butyl borane as a polymerization initiator, so when it comes in contact with moisture, radicals are generated and polymerization progresses [14].…”

“…A number of studies have described efforts to clinically preserve teeth, with particular success reported with resin bonding [5][6][7][8][9]. Sugaya et al used 4-methacryloxyethyl trimellitate anhydride/methyl methacrylate tri-n-butyl borane (4-META/MMA-TBB) resin to bond 23 teeth with vertically fractured roots, performing bonding either through the root canal or with the intentional replantation method, and reported after 6 to 74 months of observation that 18 (78%) of the teeth could be preserved [5]. Hayashi et al extracted 26 teeth with vertically fractured roots, bonded the fractured roots and replanted them [8].…”

“…Generally, if the tooth is single-rooted, the tooth is extracted, and if it has multiple roots, the root involved is resected or hemisection is performed [1][2][3][4]. A number of studies have described efforts to clinically preserve teeth, with particular success reported with resin bonding [5][6][7][8][9]. Sugaya et al used 4-methacryloxyethyl trimellitate anhydride/methyl methacrylate tri-n-butyl borane (4-META/MMA-TBB) resin to bond 23 teeth with vertically fractured roots, performing bonding either through the root canal or with the intentional replantation method, and reported after 6 to 74 months of observation that 18 (78%) of the teeth could be preserved [5].…”

Restoration of the root-filled tooth: pre-operative assessment

“…36 An alternative technique involving bonding through the root canal has also been described. 37 Whilst these preliminary studies have given optimistic results the reality is that the poor prognosis remains and there are more predictable ways of replacing missing teeth such as bridges and implants.…”