Endodontic Management of an Apical Third Horizontal Root Fracture in a Maxillary Lateral Incisor: A Case Report

Abstract

Traumatic dental injuries cause discomfort, pathologic tooth mobility, functional impairments, and esthetic concerns, and may disrupt dental arch integrity. Such injuries impose significant physical, economic, and psychosocial burdens on young individuals, potentially exceeding those from caries and periodontal disease. Root fractures represent 0.5 to 7% of the overall occurrences of traumatic dental injuries that affect the cementum, dentin, pulp, and periodontal ligament of the permanent dentition, the management strategy depends on the location of the fracture, mobility of fragments, and pulpal status. This case report describes the management of a horizontal root fracture in the apical third of a permanent maxillary lateral incisor that presented with symptoms but without mobility. Clinical and radiographic examination confirmed a stable fracture with no displacement, eliminating the need for splinting. A conservative yet comprehensive endodontic approach was undertaken. The fractured segments were carefully approximated to maintain continuity, followed by conventional root canal treatment involving both the coronal and apical fragments. Thorough biomechanical preparation and obturation were carried out to ensure adequate disinfection and sealing of the entire canal system across the fracture line. Postoperative follow-up demonstrated resolution of symptoms and satisfactory healing, with no evidence of periapical pathology. This case highlights that in selected cases of apical third horizontal root fractures, even when the tooth is symptomatic but stable, successful outcomes can be achieved through precise approximation of fragments and endodontic management of both segments. Careful diagnosis and individualized treatment planning are essential for favorable prognosis.