Immatür Orta Keser Dişlerde Horizontal Kök Kırığı: Bir Olgunun 3 Yıllık Takibi

Öz

Daimi dentisyonda kök kırıkları, yaralanmaların %0,5-7'sini oluşturur ve nadir görülür. Horizontal, oblik ve vertikal olarak sınıflandırılan kök kırıklarından horizontal olanlarda tedavi seçenekleri, takipten endodontik tedavilere ve çekime kadar geniş bir yelpazede değerlendirilir. Bisiklet kazası sonrası Akdeniz Üniversitesi Pedodonti Kliniği'ne başvuran 8,5 yaşındaki erkek hastada, immatür 11 ve 21 numaralı dişlerde palatinal lüksasyon ve horizontal kök kırığı tespit edildi. Dişler lokal anestezi altında repoze edilerek semi-rijit splint ile komşu dişlere sabitlendi. Hastaya yumuşak diyet önerildi. Splint 6. haftada çıkarıldı. Üç yıllık takipte dişlerde kalsifiye doku ile iyileşme gözlendi ve vitalite testleri pozitifti. Kök kırıklarında tamir oranı %77-80 olup, iyileşme; yaş, kök gelişim düzeyi, deplasman, mobilite, fragmanlar arası mesafe ve pulpa vitalitesi gibi faktörlerden etkilenir. Horizontal kök kırıklarında splintleme endikedir, ancak ideal süre (1 hafta-3 ay) tartışmalıdır. Bu olgularda uzun süreli düzenli takip, pulpa nekrozu ve periodontal komplikasyonların erken tespitiyle prognozu belirleyen en kritik unsurdur. Immatür daimi dişlerdeki horizontal kök kırıkları, uygun splintleme protokolü ile tedavi edildiğinde, endodontik müdahaleye gerek kalmadan kalsifiye doku ile iyileşebilir ve vitalite korunabilir. Bu durum, konservatif tedavinin başarısını vurgulamaktadır.

Anahtar Kelimeler

• Dental travma
• Horizontal kök kırığı
• Immatür daimi dişler
• Splintleme

Horizontal Root Fracture in Immature Permanent Incisors: A 3-Year Follow-Up Case Report

Abstract

Root fractures in permanent dentition account for 0.5-7% of dental injuries and are relatively rare. Root fractures are classified as horizontal, oblique, or vertical, with horizontal root fractures offering a wide range of treatment options, from monitoring to endodontic therapy or extraction. An 8.5-year-old male patient presented to the Pediatric Dentistry Clinic of Akdeniz University following a bicycle accident. Clinical and radiographic examination revealed palatal luxation and horizontal root fractures in immature maxillary central incisors (teeth #11 and #21). Under local anesthesia, the teeth were repositioned and stabilized with a semi-rigid splint attached to the adjacent teeth. The patient was advised to follow a soft diet. The splint was removed at 6 weeks. At the 3-year follow-up, healing with calcified tissue was observed in both teeth, and pulp vitality tests were positive. In root fractures, the healing rate is reported as 77-80%, with outcomes influenced by factors such as age, root development stage, fracture displacement, mobility of the coronal fragment, inter-fragment distance, and pulp status. Splinting is recommended in horizontal root fractures, though the optimal duration (ranging from 1 week to 3 months) remains debated. Long-term follow-up is critical in these cases, as early detection of pulp necrosis and periodontal complications is a decisive factor for prognosis. Horizontal root fractures in immature permanent teeth can heal with calcified tissue without the need for endodontic intervention when an appropriate splinting protocol is applied. This case highlights the success of conservative management in preserving pulp vitality.

Keywords

• Dental trauma
• Horizontal root fracture
• Immature permanent teeth
• Splinting

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