Nonsurgical Management of Horizontal Root Fracture with Necrotic Apical Segment and Coronal Cervical Abfraction using...

Horizontal root fractures are relatively rare dental findings and often pose diagnostic and treatment challenges. In addition to a horizontal root fracture, this case report also demonstrates a finding of a noncarious cervical abfraction lesion, which involves the loss of dental hard tissue from the cervical areas of teeth through processes unrelated to caries. A 22 -year-old healthy female patient was complaining of the maxillary left first premolar area with a history of dental trauma. Clinically, the tooth presented with a noncarious cervical abfraction lesion. Endodontic testing showed a negative response to cold and tenderness to percussion and palpation. Horizontal mid-root fracture with a periapical radiolucency surrounding the apical segment of the buccal root, along with periapical radiolucency of both buccal and palatal roots, and a furcal radiolucency related to the fracture line with fenestration of the buccal cortical bone were identified from radiographic examination. Root canal therapy was performed, and the necrotic apical segment beyond the fracture line was treated. Obturation was carried out using mineral trioxide aggregate as an alternative to gutta-percha, followed by a fiber post in the palatal root, and a full coverage ceramic crown. The follow-up has revealed significant healing and significant pain relief. Root canal therapy using mineral trioxide aggregate as an obturation material, combined with restorative treatment with a fiber-reinforced post and a full-coverage ceramic crown was an effective treatment for managing teeth with horizontal mid-root fracture and non-carious cervical abfraction lesions.