Disease and Health Research: Recent Developments Vol. 2

Root fractures are a biomechanically heterogeneous group of dental hard tissue injuries. They are broadly classified into horizontal (transverse) and vertical fractures, which have different aetiology, clinical behaviour and prognosis. Horizontal root fractures are primarily of traumatic origin, most often observed in the maxillary central incisors of young patients. They have a considerable biological capacity for healing by calcified tissue, connective tissue or a combination of bone-and-connective-tissue interposition, when the coronal fragment is immediately repositioned and splinted. Vertical root fractures, however, are more likely to be a fatigue-failure phenomenon of structurally compromised, often endodontically treated teeth. They may present insidiously with non-specific symptoms such as localised deep periodontal pockets, sinus tracts and angular bone loss that closely resemble periodontal or persistent endodontic disease. Therefore, diagnosis is one of the main clinical challenges in this field. This review summarises the current evidence on classification, pathogenesis, clinical features and diagnostic pathways for both types of fracture, with particular emphasis placed on the comparative value of clinical testing, conventional periapical radiography and cone-beam computed tomography (CBCT), together with adjunctive techniques such as transillumination, dye-based staining and surgical exploration. Management strategies based on fracture type are discussed, including repositioning, splinting and selective endodontic therapy for horizontal fractures and intentional replantation, surgical repair, root resection or hemisection and extraction for vertical fractures. Prognostic factors such as fracture completeness, periodontal involvement, contamination and timeliness of diagnosis are discussed in the light of new diagnostic and therapeutic advances such as artificial intelligence-assisted image analysis, high-resolution CBCT and calcium silicate-based biomaterials. We suggest a structured clinical decision-making algorithm to support evidence-based management of suspected root fractures in routine practice.