Burcu NAMAZOĞLU, Berkan ÇELİKTEN, Fatmagül ZIRAMAN

Horizontal kök kırığının endodontik tedaviyle iyileşmesi: bir olgu sunumu

Travma sonucu meydana gelen yaralanmalar ön grup dişlerde sıklıkla görülmektedir. Daimi dentisyondaki yaralanmaların % 0,5-7’sini oluşturan kök kırıkları ise oldukça nadir görülmektedir. Travma sonucunda dişin kökünde meydana gelen kırıklar kökün anatomik yapısına göre; koronal, orta veya apikal üçlüde görülebilmektedir. Kök kırıklarının tedavisi pulpanın vital veya nekrotik olmasına ve kök gelişim aşamasına bağlı olarak değişmektedir. Kırık dişte pulpanın vitalitesinin korunduğu durumlarda herhangi bir tedavi uygulanmadan iyileşme beklenirken pulpanın nekrotik olduğu durumlarda ise kök kanal tedavisi yapılmalıdır. Bu vaka raporunda, apikal üçlüsünde horizontal kök kırığı bulunan 10 yaşında erkek hastanın daimi sağ santral 11 dişinin endodontik tedavisi anlatılmaktadır. Hastanın intraoral muayenesinde üst santral dişlerinde lüksasyon olduğu ve diş etlerinde ödem ve harabiyetin bulunduğu gözlenmiş, radyolojik muayene sonucunda ise üst çene sağ santral dişinin apikal üçlüsünde horizontal kök kırığı olduğu tespit edilmiştir. Tedavi başlangıcında dişlerin splintlenerek takip edilmesine karar verilmiş ancak 3 hafta süren takibin ardından yapılan vitalite testinde santral dişlerin devital olduğu tespit edilmiş ve o seansta dişlere kanal tedavisi başlanmıştır. Fragmanları ayrılmış horizontal kök kırığı bulunan 11 numaralı dişin koronal kısmı 8 ay boyunca, apeksi açık 21 numaralı diş ise 10 ay boyunca Ca OH 2 ile apeksifikasyon tedavisi uygulandıktan sonra kök kanal dolguları tamamlanmış ve 12 ay süreyle takip edilmiştir.

Anahtar Kelimeler:

horizontal kök kırığı, kalsiyum hidroksit

Endodontic Healing of Horizontal Root Fractures: A Case Report

Traumatic injuries of teeth are more frequently observed in the maxillary anterior region. Root fractures in permanent teeth are quite uncommon with frequency between 0.5% and 7% among all cases of dental trauma. Horizontal root fracture are most commanly seen in the middle third, followed by apical, and coronal third. Treatment choices vary depending on pulp vitality and root development stage. When pulp remains vital spontaneous healing can be observed but if pulp looses its vitality endodontic treatment is indicated. This case report describes horizontal root fracture of the maxillar right central incisor of a 10 year-old boy and its healing after root canal treatment. On clinical examination both of maxillar central incisors were slightly mobile and the gingival tissues around the teeth were severaly injured and edematous. Teeth were splinted for 3 weeks after the traumatic injury and endodontic treatment was applied at the and of this period due to the loss of vitality of both teeth. Root apex of left central incisor was open and the tooth was treated with apexification using Ca OH 2 for 10 months. The coronal part of the right central incisor was also treated by using Ca OH 2 for 8 months and the apical part remaind vital

Keywords:

horizontal root fracture, Kalsiyum Hidroksit,

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Caliskan MK, Pehlivan Y. Prognosis of root-fractured permanent incisors. Endod Dent Traumatol 1996;12:129-36.
Erdemir A, Ungor M, Erdemir EO. Orthodontic movement of a horizontally fractured tooth: A case report. Dent Traumatol 2005;21:160–4.
Andreasen F M, Andreasen J O, Cvek M: Root fractures. In: Andreasen J O, Andreasen F M,Andersson L (Ed.): Textbook and color atlas of traumatic injuries to the teeth. Munksgaard, Kopenhagen, 2007; 337– 71
Birch R, Rock WP. The incidence of complications following root fracture in permanent anterior teeth. Br Dent J 1986;160: 119–22.
Andreasen F M, Andreasen J O, Bayer T: Prognosis of root-fractured permanent incisors – prediction of healing modalities. Endod Dent Traumatol 1989; 5: 11–22
Cvek M, Andreasen J O, Borum M K: Healing of 208 intraalveolar root fractures in patients aged 7–17 years. Dent Traumatol 2001;17: 53–62
Andreasen J O, Hjörting-Hansen E: Intraalveolar root-fractures: radiographic and histologic study of 50 cases. J Oral Surg 1967; 25: 414–26
Zachrisson B U, Jacobsen I: Long-term prognosis of 66 permanent anterior teeth with root-frac-ture. Scand J Dent Res 1975;83: 345– 54
Andreasen JO, Andreasen FM, Mejare I, Cvek M. Healing of 400 intra-alveolar root fractures. 2. Effect of treatment factors such as treatment delay, repositioning, splinting type and period and antibiotics. Dent Traumatol 2004;20:203-11.
Artvinli LB, Dural S. Spontaneously healed root fractur: Report of a case. Dent Traumatol 2003;19:64-6.
Ozbek M, Serper A, Calt S. Repair of untreated horizontal root fracture: a case report. Dent Traumatol 2003;19:296-7.
Polat-Ozsoy O, Gulsahi K, Veziroglu F. Treatment of horizontal root- fractured maxillary incisors—a case report. Dent Traumatol 2008;24:e91-5.
Camp JH. Management of sports- related root fractures. Dent Clin North Am 2000;44:95-109.
Westphalen VPD, de Sousa MH, da Silva Neto UX, Fariniuk F,Carneiro E. Management of horizontal root-fractured teeth: re-port of three cases. Dent Traumatol 2008;24:e11-5.
Yuzugullu B, Polat O, Ungor M. Multidisciplinary approach to traumatized teeth: a case report. Dent Traumatol 2008;24:e27-30.
Versiani MA, de Sousa CJ, Cruz- Filho AM, Perez DE, Sousa-Neto MD. Clinical management and subsequent healing of teeth with horizontal root fractures. Dent Traumatol 2008;24:136-9.
Subay RK, Subay MO, Yilmaz B, Kayatas M. Intraradicular splinting of a horizontally fractured central incisor: a case report. Dent Traumatol 2008;24:680-4.
Yildirim T, Gencoglu N. Use of mi- neral trioxide aggregate in the treatment of horizontal root fractures with a 5-year follow- up: report of a case. J Endod 2009;35:292-5.
Feely L, Mackie IC, MacFarlane T. An investigation of root fracture permanent incisor teeth in children. Dent Traumatol 2003;19:52–4
Andreasen JO. Traumatic Injuries of the teeth, 2nd ed. Philadelphia, PA: WB Saunders, 1981. p. 119-50
Yates JA. Root fractures in permanent teeth: A clinical review. Int Endod J 1992;25:150-7
Majorana A, Pasini S, Bardellini E, Keller E. Clinical and epi-demiological study of traumatic root fractures. Dent Traumatol 2002;18:77-80.
Lindahl B. Transverse intra-alveolar root fractures. Roentgen diagnosis and prognosis. Odont Revy 1958;9:10-24
Holsen A, Molven O. Overextended gutta-percha and chloropercha N-Ö root canal fillings. Radiographic findings after 10-17 years. In: Cvek M, Mejare I, Andreasen JO. Conservative endodontic treatment of teeth fractured in the middle or apical part of the root. Dent Traumatology 2004; 20: 261-269.
Cvek M, Mejare I, Andreasen JO. Conservative endodontic treatment of teeth fractured in the middle or apical part of the root. Dent Traumatology 2004; 20: 261-9.