Horizontal root fracture – anterior teeth

horizontal root fracture

Horizontal root fracture treatment protocol

Horizontal root fracture of the anterior tooth has pretty good survival rates. The treatment options for a horizontal root fracture depend on where the fracture occurs.

Horizontal fractures can last for a long time with a high success rate

The general treatment should be to save the tooth. Apical fractures have great long term survival rates without any type of treatment at all. Even coronal fractures can do very well if we place a splint. Sheridan JADA 2019 shows a couple of cervical fractures that are decades old.

Anterior tooth horizontal root fracture migration over the years.
Not all teeth are a success though. As you can see this coronal portion is migrating and may eventual fail.

Horizontal root fracture of the anterior teeth research

10 year survival rates of anterior teeth with a horizontal root fracture correspond to area of fracture Andreasen 2012

  1. 89% for apical fracture
  2. 78% mid root
  3. 67% oblique mid root cervical
  4. 33% cervical


Horizontal root fracture causes necrosis of coronal portion and apical portion remains vital Andreasen 1967 and Hitchcock 1985 and Cvek 2004

Treatment is done JUST to the fractured coronal tooth segment leaving the apical alone since usually remains vital Cvek 2004 and Cvek 2008

Treatment is completed with MTA NOT gutta percha.  Many articles on this look at page 25 for list article implantpracticeus.com/continuing-education/ce-articles/415-multi-disciplinary-approach-to-the-treatment-of-traumatic-root-fracture-a-case-study

List of horizontal root fracture splint times
Splint times from AAE

Horizontal root fracture of primary teeth

Due to relatively high survival rates RCT is NOT done as a prophylactic measure for PRIMARY teeth. Flores 2007 IADT guidlines

Detecting a horizontal root fracture

Typically these are not as difficult to detect as the vertical root fracture. A normal PA x-ray can usually see a horizontal fracture. Below is an example of one that was a tricky diagnosis that without a CBCT, we could not have found.

CBCT of horizontal root fracture of a canine.


Alternative treatment options for a horizontal fracture of an anterior tooth.

Zhang 2024 IJPRD has an interesting technique.  Surgical extrusion is always an option as well.