Fracture necrosis: diagnosis, prognosis assessment, and treatment recommendations

The presence of cracks and fractures in teeth can pose difficulties in diagnosis, prognosis assessment, and treatment recommendations. When a tooth has no significant restorations or caries, whereby the pulp is nonvital in the absence of a luxation injury, it is suggested that this necrosis is likely caused by a significant longitudinal crack that extends from the occlusal surface and into the pulp. This type of presentation has been termed "fracture necrosis."

Twenty-seven teeth with nonvital pulps were evaluated that had no restorations or minimally deep restorations and no signs of caries. These teeth were extracted and evaluated as to the depth and location of any potential fracture.

All evaluated teeth were found to have cracks that extended from the occlusal surface into the pulp and progressed to an external root surface.

Pulp necrosis, in the absence of restorations, caries, or luxation injuries, is likely caused by a longitudinal fracture extending from the occlusal surface and into the pulp. Based on the available literature, these types of teeth may have a poor prognosis after endodontic treatment, with the potential ramification of extensive periodontal and/or periapical bone loss. Extraction may be considered as the primary treatment option.