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

Yıl 2025, Cilt: 4 Sayı: 2, 147 - 152, 28.08.2025

Hüseyin Karayılmaz , İrem Kapıcı

https://doi.org/10.62268/add.1700724

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

Öz

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.

Anahtar Kelimeler

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

Kaynakça

• 1. Luxation I. Management of Periodontal Trauma. Oral Maxillofac Surg Dogs Cats. 2019;218.
• 2. Deshpande A, Deshpande N. Flexible wire composite splinting for root fracture of immature permanent incisors: a case report. Pediatr Dent. 2011;33(1):63–6.
• 3. Kindelan SA, Day PF, Kindelan JD, Spencer JR, Duggal MS. Dental trauma: an overview of its influence on the management of orthodontic treatment. Part 1. J Orthod. 2008;35(2):68–78.
• 4. Ranka M, Shah J, Youngson C. Root fracture and its management. Dent Update. 2012;39(8):530–8.
• 5. Andreasen JO, Andreasen FM, Andersson L. Textbook and color atlas of traumatic injuries to the teeth. John Wiley & Sons; 2018.
• 6. Wölner-Hanssen AB, von Arx T. Permanent teeth with horizontal root fractures after dental trauma. A retrospective study. Schweiz Monatsschr Zahnmed. 2010;120(3):200–12.
• 7. Fouad AF, Abbott PV, Tsilingaridis G, et al. International Association of Dental Traumatology guidelines for the management of traumatic dental injuries: 2. Avulsion of permanent teeth. Dent Traumatol. 2020;36(4):331–42.
• 8. Deshpande A, Deshpande N. Flexible wire composite splinting for root fracture of immature permanent incisors: a case report. Pediatr Dent. 2011;33(1):63–6.
• 9. Curzon MEJ. Handbook of dental trauma: a practical guide to the treatment of trauma to the teeth. 1999.
• 10. Çalişkan MK, Pehlivan Y. Prognosis of root‐fractured permanent incisors. Dent Traumatol. 1996;12(3):129–36.
• 11. Kucukyilmaz E, Botsali MS, Keser G. Treatments of horizontal root fractures: Four case reports. J Pediatr Dent. 2013;1(1):19–23.
• 12. Andreasen JO, Andreasen FM, Mejàre I, Cvek M. Healing of 400 intra‐alveolar root fractures. 1. Effect of pre‐injury and injury factors such as sex, age, stage of root development, fracture type, location of fracture and severity of dislocation. Dent Traumatol. 2004;20(4):192–202.
• 13. Kirzioglu Z, Sentut TK, Karayilmaz H, Erturk SO. A clinical study of 27 cases of dentoalveolar root fractures in children and adolescents. Eur Arch Paediatr Dent. 2008;9:98–101.
• 14. Yates JA. Root fractures in permanent teeth: a clinical review. Int Endod J. 1992;25(3):150–7.
• 15. Kahler B, Heithersay GS. An evidence‐based appraisal of splinting luxated, avulsed and root‐fractured teeth. Dent Traumatol. 2008;24(1):2–10.
• 16. Isaksson H, Koch G, Bakland LK, Andreasen JO. Effect of splinting times on the healing of intra‐alveolar root fractures in 512 permanent teeth in humans: A Scandinavian multicenter study. Dent Traumatol. 2021;37(5):672–6.
• 17. Fouad AF, Abbott PV, Tsilingaridis G, et al. International Association of Dental Traumatology guidelines for the management of traumatic dental injuries: 2. Avulsion of permanent teeth. Dent Traumatol. 2020;36(4):331–42.
• 18. Flores M, Andersson L, Andreasen J, et al. Guidelines for the management of traumatic dental injuries. I. Fractures and luxations of permanent teeth. Endod Topics. 2006;14(1):102–10.
• 19. Coşar MS. Management of a horizontal root fracture in an immature maxillary central incisor: a case report. Clin Dent Res. 2025;49(1):57–63.
• 20. Itoh T, Kojima Y, Nishioka T, Maki K, Kimura M. Root fracture in immature anterior teeth followed for 15 years. Dent Traumatol. 2005;21(4):229–33.
• 21. Saraf BG, Dhindsa A, Garg S, et al. Management of root fractures in young immature permanent teeth: Three case reports. Int J Clin Pediatr Dent. 2024;17(3):352–6.
• 22. Zeid STA, Edrees HY. Root fracture healing outcome after a revascularization procedure: an 8-year follow-up case report. J Clin Pediatr Dent. 2022;46(5):88–93.
• 23. Marjy Z, Slutzky-Goldberg I. Retreatment of a failed regenerative endodontic treatment in an immature tooth with a horizontal root fracture: A case report. Int J Clin Pediatr Dent. 2024;17(10):1168.