Delayed presentation of an apical-third horizontal root fracture: conservative endodontic management and aesthetic...

Horizontal root fractures represent an uncommon form of dental trauma, accounting for approximately 0.5%-7% of all injuries to permanent teeth. Pulp necrosis occurs in nearly 25% of overall root fractures, most frequently within the first few months after injury. Outcomes in cases presenting long after trauma, however, are not well documented. A 33-year-old female sought care for discoloration of the maxillary left incisors one year after sustaining dental trauma. Clinical findings, supported by radiographic assessment, confirmed pulpal necrosis in teeth 21 and 22. An apical-third horizontal root fracture was identified in tooth 22. Endodontic management was limited to the coronal fragment, using a calcium silicate-based bioceramic sealer, with the apical segment left undisturbed. Following endodontic stabilization, aesthetic rehabilitation was achieved with lithium disilicate veneers extending from teeth 11 to 23. At the 12-month review, radiographic evaluation demonstrated hard-tissue repair at the fracture interface and evidence of gradual apical fragment resorption. The aesthetic result remained stable. This case underscores that delayed presentation of apical-third root fractures does not necessarily compromise healing. When biological principles are respected and treatment is confined to the necrotic coronal segment, preservation of the vital apical fragment can still yield favorable outcomes.