Operative dentistry aje qualtrough, jd satterthwaite la morrow, pa brunton

Fracture involving both crown and root
A decision must be taken as to whether the tooth can be root filled and
a satisfactory restoration ultimately provided, or the tooth should be
extracted.
Root fracture
Although the reported incidence of these injuries is low the true 
number may well be higher as ‘unknown’ fractures are sometimes
revealed. They most commonly occur in the middle third of a fully
erupted, fully formed tooth and healing is possible along similar lines
to healing of a fractured bone.
The avulsed tooth
This most commonly occurs in males, in upper incisors and par-
ticularly in younger patients with protrusive teeth. In the majority 
of cases, reimplantation is carried out but no guarantee of success
should be given to the patient. Replanted teeth are often subject 
to resorption which may be either inflammatory or replacement
(ankylosis).
Endodontics – further considerations


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The loose tooth
Any tooth loosened in its socket may become non-vital as a result of
damage to apical blood vessels. Regular reviews are thus required to
assess clinical and radiographic changes.
Splinting
Splints are used to stabilise teeth loosened in their sockets, teeth 
with root fractures, teeth lost (avulsed) and replanted, fractures of the
alveolus and fractures of facial bones. Splinting is ideally provided
directly by joining adjacent teeth together with an adhesive restorat-
ive material (such as glass-ionomer cement or bonded composite), 
or a piece of wire (for example orthodontic wire) retained on the teeth
by an adhesive restorative material or orthodontic brackets. Other
techniques such as the use of interdental/eyelet wires have been
described, though these may be traumatic to the gingival tissues and
may extrude a tooth if inappropriately applied. Teeth may also be
splinted with a removable appliance constructed on a cast. The most
suitable method will vary in each case, but generally that which is
least intrusive whilst fulfilling its role should be used.
The duration of splinting varies depending on the type of injury.
Where soft tissue only has been injured (for example a luxation injury)
then the period of splinting may be as little as one week or less. Where
there is significant hard tissue injury (for example alveolar fracture 
or root fracture) a much longer period of wear (up to 3 months) is
required. Whatever method of splinting is employed, care must be
taken that the splint is neither too rigid nor placed for too long as both
these will increase the risk of ankylosis.