Conservative endodontic management using a calcium silicate bioceramic sealer for delayed root fracture: A case report and review of the literature

Abstract

Background: The success rate of conservative endodontic management for root fracture varies greatly based on different methods used. It has been rarely reported that calcium silicate-based materials are applied in root fracture treatment.

Case summary: A 38-year-old male patient presented with spontaneous pain from the upper left anterior teeth for 1 wk. The spontaneous pain was subsequently relieved, but pain on mastication persisted for 3 d. The patient had a dental trauma from a boxing match 15 years ago. Cone beam computed tomography showed that the maxillary left central incisor had oblique fracture lines and a radiolucent lesion around the fracture line. The tooth was diagnosed with an oblique root fracture with no healing and symptomatic apical periodontitis. In the following conservative endodontic management, the coronal and apical fragments of the canal both were chemo-mechanically prepared and obturated using a single cone gutta-percha with iRoot SP (Innovative BioCreamix Inc, Vancouver, Canada), a new calcium silicate-based bioceramic root canal sealer. At follow-ups at 1, 6, 12, and 24 mo, the patient was asymptomatic and the radiolucency around the fracture line was healing radiographically.

Conclusion: Conservative root canal treatment is an alternative treatment in some cases of oblique root fracture with no healing. The application of bioceramic sealers and single core obturation techniques may also be essential to obtain an excellent outcome.

Keywords: Calcium silicate-based sealer; Case report; Endodontic treatments; Oblique root fracture; Single core obturation; iRoot SP.

Figure 1

Pre-operative photograph from the lip-side of the anterior teeth. The composite resin restorations in mesial incisal angle of both maxillary central incisors were stable, but the margins had been stained.

Figure 2

Pre-operative panoramic radiograph. The orange arrows point to the suspected fracture line.

Figure 3

Pre-operative cone beam computed tomography imaging. A-C: Axial (A), coronal (B), and sagittal (C) views of the cone beam computed tomography showed that both of the maxillary central incisors had oblique fracture lines, and a 3 mm × 4 mm radiolucent lesion set around the fracture line.

Figure 4

Periapical radiographs. A: Periapical radiograph showing the file at the fracture line; B: Periapical radiograph for determining the working length.

Figure 5

Periapical radiographs. A: At immediate post-obturation; B: 1-mo follow-up; C: 6-mo follow-up; D: 12-mo follow-up; E: 24-mo follow-up.