Management of Symptomatic Horizontal Mid-root Fractures after Unsuccessful Orthograde Endodontic Retreatments

This case report describes the management of symptomatic horizontal mid-root fractures in previously traumatized central incisors, which initially had been treated endodontically and retreated afterwards. A 26-year-old female, who had suffered a traumatic injury to the maxillary anterior teeth, was referred owing to the failure of the corresponding orthograde endodontic retreatment and consequent pain/discomfort. Periapical radiographs and cone beam computed tomography showed that both central incisors had horizontal root fractures in their middle third, root canal fillings in their coronal segments, a considerable dislocation of the apical fragments and large radiolucent lesions between their apical segments and coronal fragments. Based on the obtained radiographic and clinical findings, a surgical endodontic retreatment approach for the main segments without removing the apical fragments was applied employing calcium-enriched mixture (CEM) cement as the retrograde biomaterial. Thirty-month clinical and radiographic follow-ups demonstrated successful outcomes. This case report showed the healing potential of horizontal mid-root fractures after surgical endodontics using CEM cement without removing apical fragments.