Journal of Interdisciplinary Dentistry

CASE REPORT
Year
: 2011  |  Volume : 1  |  Issue : 2  |  Page : 108--110

Endodontic stabilizers for treating mid root fractures


Sunandan Mittal, Tarun Kumar, Vishal Aggarwal, Ramta Bansal, Dilpreet Kaur 
 Department of Operative and Endodontics, Dasmesh Institute of Research and Dental Sciences, Faridkot, Punjab, India

Correspondence Address:
Sunandan Mittal
Department of Operative and Endodontics, Dasmesh Institute of Research and Dental Sciences, Faridkot, Punjab
India

Abstract

Surgical endodontic endosseous stabilizer by embedding an inert chrome cobalt alloy through the root canal into the osseous structure is a reliable procedure to lengthen the existing root and provide individual tooth stabilization. In this case report, an endodontic stabilizer was used in conjunction with surgical intervention and bone grafting. This case was considered successful on the basis of clinical and radiographic evidence.



How to cite this article:
Mittal S, Kumar T, Aggarwal V, Bansal R, Kaur D. Endodontic stabilizers for treating mid root fractures.J Interdiscip Dentistry 2011;1:108-110


How to cite this URL:
Mittal S, Kumar T, Aggarwal V, Bansal R, Kaur D. Endodontic stabilizers for treating mid root fractures. J Interdiscip Dentistry [serial online] 2011 [cited 2019 Sep 20 ];1:108-110
Available from: http://www.jidonline.com/text.asp?2011/1/2/108/85030


Full Text

 Introduction



Root fractures due to trauma of anterior teeth are commonly encountered in day-to-day endodontic practice. As it is well documented that coronal third and apical third fractures have good prognosis, the mid-root fractures poses a dilemma to the treating endodontist. Usually mid-root fractures are displaced or angular fractures, which are difficult to align via conventional root canal therapy. Even if a dentist is able to align them, they usually have a poor prognosis.

The most common treatment alternative to mid-root fractures is the extraction of the apical fragment. However, this treatment compromises the crown-root ratio. To compensate for the reduced crown-root ratio, the use of endodontic stabilizers has been attempted by Frank. [1] The endodontic endosseous implants were first reported by Strock and Strock [2] in 1943. According to Weine, [3] the endodontic stabilizer with no communication between oral cavity and the implant appears to have an outstanding chance for long-lasting effectiveness. Feldman and Feldman [2] advocated the use of endodontic stabilizers as a mean of stabilizing and retaining seemingly nonretainable teeth. Endodontic stabilizers are biocompatible and have the additional advantage of maintaining the periodontal membrane attachment of the remaining tooth.

The basis for an endodontic stabilizer is the use of chrome cobalt pin as the implant material. This alloy is composed of 65% cobalt, 30% chromium, and 5% molybdenum. Bernier and Canby have verified nonelectrolytic, inert properties as well as excellent tissue tolerance to the material [4] . The endodontic stabilizer increases the root anchorage in the bone by the extension of the artificial material beyond the limit of the alveolar socket within the limits of the alveolar bone and thus helps in stabilizing the teeth with compromised alveolar support.

The aim of this case report is to show the successful result of the endodontic endosseous stabilizer which was placed in conjunction with surgical intervention.

 Case Report



A 22-year man reported to the Department with a history of automobile accident. Clinical examination revealed splinted anterior teeth (done by the referring practitioner) and the gum tissue overlying the roots of the upper right central incisor was soft and full of fluid. The involved tooth was extremely painful. The periodontal probing of the sulcus revealed depths of 2-3 mm. IOPA of the maxillary anterior region revealed a horizontal mid root fracture with 11 and greater amount of external root resorption [Figure 1].{Figure 1}

As both the fragments were displaced apart, it was decided to extract the apical fragment surgically and place the endodontic implant. The condition was informed to the patient and he consented to save the involved tooth by a surgical endodontic endoosseous implant procedure. The patient was scheduled for removing the nonreparable portion and insertion of an alloy implant through the canal.

Procedure

After securing adequate anesthesia, a full thickness flap was raised and the defect in the cortical plate was observed over the root of the involved tooth after enlarging bony access to the root. The soft granulation tissue and the fractured apical segment were removed. The area was thoroughly irrigated with diluted betadine solution. Then, endodontic access opening was modified with 11 under rubber dam isolation. The biomechanical preparation of the canal was accomplished using the gates glidden drills no. 4, 5, and 6. The root canal and the bony defect were thoroughly irrigated with normal saline. The bleeding was controlled and an 18 mm implant was selected and coated with luting type 1 Glass Ionomer cement for the cementation of the implant. The implant was then inserted through the root canal into the periapical osseous defect to lengthen the existing root.

The bony crypt was irrigated with normal sterile saline, and the bone graft (Bio oss) [Figure 2] was placed to fill the apical bony defect.{Figure 2}

The whole area was inspected for cleanliness and the flap was repositioned and sutured. A postoperative radiograph was then taken [Figure 3].{Figure 3}

When the patient was reviewed after 1 month, the tooth was found to be asymptomatic. Three months follow-up was done. The patient showed satisfactory healing. The tooth was asymptomatic [Figure 4]. On vitality testing 12, 21, and 22 were nonvital. Root canal treatment was performed on the same. Full coverage porcelain-fused metal crowns were then given to restore the proper form and function of the tooth.{Figure 4}

Three-year follow-ups revealed excellent bone formation around the endodontic stabilizer [Figure 5].{Figure 5}

 Discussion



This case report illustrates a successful case treated with an endodontic stabilizer. Endodontic stabilizers are rarely used in these days because of their controversial success rate. However, a review of literature shows that the failure rate of stabilizer increases in cases where the applicability and indications are overlooked. Careful case selection with a proper technique drastically improves the success rate of the endodontic stabilizer.

 Conclusion



The reduced crown-root ratio can be improved by placement of an inert chrome-cobalt alloy or stainless implant through the root canal into the periapical area. The success of this technique is illustrated in this case report.

References

1Frank AL. Improvement of crown root ratio by endodontic endosseous implant. J Am Dent Assoc 1967;74,451-62.
2Strock AE, Strock MS. Method of reinforcing pulpless anterior teeth - preliminary report. J Oral Surg 1943;1:252-5.
3Weine FS, Frank AL. Survival of the endodontic endosseous implant. J Endod 1993;19:524-8.
4Khayat A, Ravanshad S: Improvement of crown root ratio by endodontic endosseous implants; a 10 year follow up. Med J Ira Hosp 2001;3:48-50.