vertical fractures in the roots of the teeth treated for
drendo root canal vertical fracture vertical fractures of the roots of
that the vertical fractures of the roots of teeth treated for Pia are ticking time bombs in our daily practice may explode any moment, especially after the restoration of dental treatment for Pia
Tejert which you translated this topic useful I hope that you will find it of interest
Vertical fractures of the roots of teeth treated for Pia
Diagnosis and clinical management
Mixing is the most widely used in dental treatment for Pia, where the warning is bad and are difficult to disperse the case for other diseases in many cases, which require accurate vertical fracture discrimination for other demonstrations of endodontic disease and what about the Sunni Arabs.
Usually treated vertical root fracture Bakla Age, as the problem begins to emerge since the filler channels or later because of the survival effect of influencing the efforts of a tooth, but this time before the forces of chewing. Usually arises fracture vertical - depending on the nature of the stressful factors - from the peak of age and then extends to the coronary, or may be generated from the cervical region of the root and tends to peak. In the horizontal direction fracture extends laterally from the wall of the channel to the root surface where fracture may present incomplete and includes only a single aspect of the root.
Is a complete break in the buccal root of the medial lower molar of A, and giggled at the upper single root B ... Note that the fracture extends from the root canal wall to Alkhadda from the roots.
The full break is claimed, to the opposite side of the root canal and includes two surfaces Jdhiraan
Cross-section perpendicular to the fracture in the upper notes giggled through a fully extended break from the vestibular Elyallsanah is observed in fully extended break from the buccal to the lingual of the upper Baknatin giggled.
The phenomenon of vertical fracture in dental treatment for Pia event very frustrating for both doctor and patient for several reasons:
Fracture can not be diagnosed only after several years of endodontic treatment or compensatory.
Final diagnosis of the fracture itself is difficult because of lack of distinctive signs and symptoms and / or a lack of radiographic manifestations of the ideal, so is the differential diagnosis from other diseases a major challenge.
The multiplicity of possible causes of the break.
Is usually the only solution for such cases is infected tooth extraction.
The pathogenesis
Whether the fracture fully or not fully, it will extend to Arabatma about Sunni where growing soft tissue above the fracture and increase the separation of parts of the root, and through contact with the oral cavity through the gutter gingival accumulate foreign objects and debris escape of food and germs in the area of fracture and then to the space formed raising the inflammatory process within the fabric of what about the Sunni adjacent tissue, leading to the disintegration of Rabat and alveolar bone loss and a weave Habibi.
Progressing towards the peak Altakrb marrow and adjacent direction very quickly, and be Altakrb rapidly in the roots of the teeth and where the thickness of the plate a few bony vestibular (Kaladwag upper and medial roots of the Rh lower teeth are more susceptible to break the roots).
Dependent inflammatory process in the surrounding supporting tissue in the case of root fractures is limited to the peak of the root (without contact with the oral cavity) on the release irritants contained within the root canal, including germs and article footnote.
Models of bone absorption
Are the upper and lower premolars and molars of the roots of humanism humanism rooted teeth and more likely to break where the bone is associated Bamtsast described the openness that is usually seen in the vestibular plate by 90% of cases. Mainly absorbed by the plate when developed vestibular incision and bone narrow absorption begins in the direction of any coronary peak that is consistent with a model accounting for the radical break Amtsasia longitudinal bone or ovoid.
Incision and the opening of a narrow bony skeleton in full plate for the root of the vestibular Laugher The upper bone in the immediate vicinity Fmaizal bone intact.
Altakrb bone becomes more extensive in the advanced stages and extends laterally to the adjacent areas, and see such a case, after the lifting of the slide and remove the granulation tissue ....
Fracture perpendicular to the root of the Laughing first basement was discovered after removing the temporary crown notes the existence of openness perfect for plate vestibular extended to Aljhhalmlasqh have been discovered are the other after the lifting slide A_i_kavih a complete, tooth extraction where he found the granulation tissue fills the place Altakrb bone image shows x-ray in the presence of transparent X-ray large in the medial but in fact it also includes the peak region and a third peak of the lateral root. In the image show the amount of bone lost after extraction.
In the lingual side is a bone Aasvnge with thick crust Draih make the process of absorption of a bone lesion in character with the survival of high bone plate intact. Radiograph does not show a peak at any Hvovih fission or the openness of the bone, and then can not be the case only after the discovery of an extension to Alafah aspects for adjacent areas. (As in the figure above).
There is another model for the absorption of bone is the "window" when the fracture occurs somewhere along the root and is usually in the vestibular not including parts or coronary peak.
Window to interview bone fracture in the vertical side of the vestibular giggled upper
Of course, is not a window bone essential mark of a broken vertical it is found in 10 cases out of 110 have examined in one study, as was the fraction corresponds exactly where absorption and stayed bone intact on both sides of the fraction (Dhiroya and coronal, meaning the absence of any lesion in direction after the lifting of gum where the slide does not have any contact with the break veli, as seen and is similar to an abscess dentoalveolar abscess told the origin in such cases of the ten "windows."
Infection rates
The fractions of the roots vertical one of the main reasons for tooth extraction treatment for Pia at the moment than in the past, which may be the result of the awareness of dentists that dental treatment for Pia are more likely to break as well as reports that shed light on the difficulty of diagnosing such cases, however There is not confirming that the vertical fractures are the main reason for the extraction of those teeth.
Evidence taken from a series of clinical cases and follow patients who performed the restoration operations of artificial teeth in addition to studies based on X-rays that the incidence of these fractures is about 2-5%, but this figure may be a result is not accurate at all, due to the possibility that cases involving fractures in the study had diagnosed accurately where lesions were either peak or supportive tissue injuries.
Now coincides with the largest percentages of root fractures, in the two studies was the lack of dental treatment for Pia reached the ratio of 11-20%.
Symptoms and clinical signs
Diagnosis is a challenge in itself, as similar symptoms and clinical signs and radiographic with those associated with the pest peak is healing or with demonstrations of certain diseases, Periodontitis, and therefore must take a quick decision somewhat in order to avoid any shortage in the alveolar bone may result in difficulty in re- restoration of the region such as placing implants or something like that.
To that data remain insufficient diagnostic Kindle received surgical diagnosis opposition attempt by the patient (surgical detection of the root), which delays the diagnosis.
Overall, some comparative studies analyzing the symptoms and signs associated with vertical fractures as shown in the table.
The most frequent symptoms were:
Altakrb marrow, mild pain, a pocket, and worsening of chronic lesions over time.
I have complained more than half of the patients from some form of mild pain Almertavq with a sense of pressure when chewing, and pretended to more than 35% of cases the presence of abscess was considered ideal for Ktefaqm chronic inflammatory lesion in the region, Table -1. Although the Altakrb bone is ideal for the appearance of tissue injury in addition to supporting a fistula gingival in endodontic treatment is not successful, the value of these diagnostic signs specific to a broken vertical.
Than shown in Table 1 ... observed the presence of gingival fistula in 13-42% of cases of vertical fractures where the pocket is placed very close to the edge of the gums, while the fistula facilities of the teeth with failed endodontic treatments be close to the peak.
Pocket facilities for high vertical break in the root of the medial lower second molar. Sounding shows the gingival buccal plate loss. The picture shows the peak radial bone loss on the medial sides and lateral root of the medial and suppositories are placed within the fistula Alcottabaraka gum and bone Altakrb formed. We also note the presence in the root along the medial Omelgma.
The two tracks are on both sides Jepien vestibular and lingual is a definite distinctive to the presence of a vertical fracture.
Jepien tracks high in the two vestibular A and B lingual escorts to break the vertical in the medial root of the second lower molar.
Note Tamse that there are 35% of cases associated with fistula gingival and 24% associated with destruction of bony deep often seen in the vestibular, and the sounding was confined to the region corresponding line break root and is a narrow area are difficult to quantify and explorations of course, But the process becomes easier when sounding Altakrb bone extends to the peak and sides.
And Ki_khis differential, we find that probe the depth of pockets in fractions vertical be in specific areas but cases associated injuries weave supportive includes the sounding enclaves several teeth, so it is important for a doctor to distinguish between Altakrb marrow resulting in either case, it begins with loss bone in both cases starting from the edge gums and lead towards the peak but progressing slower approach in supporting injury (compared to the broken vertical) tissue abscesses and excluded what about the Sunni.
Diagnosis is crucial to break the vertical slice through the work of exploration, if not found any cracks or windows and / or signs of any decisive break to the presence of vertical lift during the slide to be cut peaks was carried out.
Do not forget another thing is the possibility of a break yet again in the lingual side more harm to the alarm condition.
Radiographic manifestations
Definite diagnosis can be made to break the vertical radially only two cases:
* First when you see the line break Kchwefah radial high within a cluster Ivory, these lines difficult to identify and can not be viewed in the context of image radial peak normal, and with, it was noted both Rud & Omnell its presence in 37.7% out of 375 fractures perpendicular.
* The second is to view the features of the clear separation of parts of the root is usually associated with significant loss of bone surrounding the root.
Loss of bony large facilities to break the vertical at the root of the molar medial lower A and upper B Laugher second
Doctors have in most other cases that need to be X-rays to make assumptions based on the many types of multiple skeletal Altakrb which - unfortunately - may be associated with lesions weave a supportive and other similar pests pulposus. And you may not see bone lesions in some cases, delaying diagnosis and definitive treatment.
The Rud & Omnell linking both the direction and quantity of bone fracture Almtakrb and radiographic appearance and emphasized that the extent along the Great Ocean Altakrb broken depends on the place of root fracture and the amount of time since winning the past, Meister also stressed the importance of time. Found during these studies that the difficulty of immediate verification of a fracture through the X-rays resulting from the sequence required for the proliferation of soft tissue between the lips of fracture and thus the separation of its parts, and overlay the root with the bone makes it difficult to detect transparency radial accompaniment especially, and that fraction gets in the direction of the lingual vestibular often also Altakrb marrow in the early stages occurs only in the region corresponding to the break, and the bone becomes Altakrb more pronounced when extending to the sides. In case of doubt the existence of a vertical fracture at the age of what can be done two Haaitin Dhiroatin Mojuztin Bzawatin different in the horizontal plane.
Found Lustig and colleagues through the study of model absorption marrow in 110 cases break that 72% of patients were infected with symptoms and signs of infection chronic (Sunni movement, the path of my pocket - fistula - destruction of bone) or interactions acute situation or loss of bone adjacent higher than that Altakrb with the have been detected early in the vertical fracture.
Angular bone loss in the brutal one-third of the coronary giggled when a patient with lower injury on Sunni A. The depth of the pockets in the two medial vestibular and deeper compared with other teeth, pushing to take a second X-ray B and change the angle of displacement in the horizontal plane, which also revealed the presence of bony destruction of the style Aldaamfayalthelthen Aeltagyan from the root. Observed a fracture in the root after tooth extraction.
Despite the difficulties encountered confirm the diagnosis of fracture vertical dental treatment for Pia remains there are several signs of X-ray should be taken into account as indicators of a strong, Val "halo" seen in the X-ray, which is the sum of Alchwevian Alhaaitin peak and peripheral associated with a large number of cases of fracture doubtful in the X-ray study included 102 cases giggled upper address to Pia.
Note the appearance of the aura surrounding Cpovih Bjdhir ANSI broken lower molar vertically extended Elyaljhh coronary about rooted junction A. We also note Hvovih appearance of the aura in the humanism in the second upper Laugher B.
The absorption of angular summit alveolar bone along the root in one hand or two without the area includes the peak (to mimic the appearance of radiation injury Sunni PERI) found in 14% of cases.
Tamse also found the appearance of the aura by 37% and the form "PERI Sunni" Altakrb of bone fracture in the case of vertical in 29% of the roots of humanism the lower molars. Employment has led some of the variables in this study Kasabh crossroads roots (63%) and the presence of amalgam dowel (67%) expect to get broken in 78% of cases, and there are other studies supported these findings.
Hvovih X-ray pattern of the "Sunni PERI" includes the entire medial side of the upper and giggled the second part of the coronary lateral surface A. The same model Altakrb break the root seen in the medial lower molar B. We also note the presence of suppression Alcottabaraka Altakrb bone in place on the surface of the medial root. Also Hvovih X-ray in the region of the junction.
Table 2 shows the results of 6 studies on models Altakrb marrow in cases of vertical root fracture. Despite the differences in sample size in each study and the study design and approach, but most of the manifestations of radiation damage was a skeleton on the side of the root with the appearance of the halo. Help of modern technology in the pivotal radiographic imaging Computed tomography CT (conventional) in the detection of root fractures without the ability to detect small cracks or poetic, but other methods such as may be granted Alahadot evidence that early break put into clinical use.
Diagnosis
Include symptoms and clinical signs and radiographic that may indicate the possibility of breaking a radical or a Sunni perpendicular to each of the following: destruction of bone deep in the vestibular, fistula is high, and absorption of bone typical of lifting slice exploratory as well as transparency bone radiographs taken my appearance "halo "style and" supportive. " And to confirm the diagnosis should be on the practitioner to follow the following steps:
* Determine the roots of teeth and infected fractures doubtful.
* Take a full clinical history of age of suspect.
* Check out my bed of pain when biting or the presence of long-term sense of discomfort.
* An exploration of the gingival tissues of the peri-dental to verify the presence of bony destruction, particularly in the vestibular surface of the roots of the suspect.
* Take at least two Haaitin Bzawatin to distinguish between two different line breakage and radial model of transparency surrounding the root.
* Raise the slice exploratory usually help in the detection of bone loss model and the fracture.
Causal factors
Divided into factors and other predisposing illness:
First, the predisposing factors:
Include loss of healthy tooth tissue as a result of necrosis or trauma which increases the chances of cracks in the block Ivory evolve to fractures later. The unique anatomy of the root (dimension of the medial - lateral dimension of the narrow compared with the vestibular lingual) makes them susceptible to fracture, especially in the later stages when still another amount of tooth tissue in the context of the preparation of channels to receive the pegs.
The loss of teeth treated for Biya to moisture and formation of early cracks in dentin and alveolar bone loss of support, all of the factors predisposing to fracture roots vertically.
Second, pathogens:
The treatment procedures and the use of pegs Alguenioa root of the key factors in fission roots. The expansion of one-third of the root canal coronary important in helping to determine the exact length factor and clean organic waste within the channel and multichannel filling the excessive use of rotary instruments during preparation by cutting off the Ivory excessive bends to settle Alguenoah weaken the structure of the roots.
Rotten in the channels should create a balance between the need to get rid of the rotting remains of ivory and between maintaining sufficient thickness to allow ivory to bear the forces of chewing.
It also should be particular attention to the maintenance of an adequate amount of ivory in the roots of the most likely to break Kaladwag the upper and lower roots of humanism and of the lower molars.
The lateral condensation technique of the most important factors that causes fission roots, but the study Gimlin and the use of the means of calculation showed that the pressure applied to the height of the root is much less compared with the vertical condensation technique. Using the Instron machine showed that the pressure by 16 kg is enough to make a radical break which is not compatible with the clinical case where the power of 3 kg is enough to make a vacuum Aah appropriate to intensify Alcottabaraka suppositories.
Regardless of the force applied to laboratory experiments have shown displays the roots to abnormalities of the teeth exposed to the pressure.
Splits the root can be also because of the reconstructive treatment after age Alguenoah Kalthouder excess channels in order to receive a radical wedge, wedge inappropriate use of and access to those placed harmless renovations inside channels.
Currently prefer to use pre-made wedges with parallel sides and rounded edges of the introduction of neutral or fiber-reinforced composite pegs which have the same coefficient of elasticity ivory.
The clinical management
The destruction of the supporting tissues corresponding to the fracture zone as a result of the continuous leakage of irritants Kalvevanat germ to the area to prevent any handling of the situation with the exception of tooth extraction. Some laboratory tests were used for the CO2 laser and Nd-YAG in order to melt and merge parts of the fracture in an attempt to save the tooth extraction, but it has not proven effective.
Recently showed the broken stick parts Cement resin in 3 Adwag top and replant success spread through the observation period between 18 months - 3 years, while in the posterior teeth is up to several roots treated either Ptnsif root (eradication) or removal and restoration of the broken part Age again.
