title: Influence of a parafunctional oral habit on root fracture development after trauma to an immature tooth.
abstract: Root fractures in immature teeth are rare because the resilience of the alveolar bone is more favorable to the occurrence of luxation. This article reports a case of traumatic injury in an immature permanent tooth that progressed to root fracture, having a parafunctional oral habit as the possible modifying factor of case evolution. A 12-year-old boy presented for treatment complaining of a defective restoration and mild pain on the maxillary right central incisor. The patient had a history of crown fracture in this tooth due to trauma 2 years before. The clinical examination showed healthy gingival tissues and no abnormal tooth mobility, whereas radiographic projections revealed healthy periradicular tissues, incomplete root formation, and no visible root fracture. As pulp necrosis was diagnosed, calcium hydroxide therapy was started for canal disinfection and subsequent obturation. However, after 4 weeks of treatment, a horizontal fracture line was observed radiographically in the root's middle third. The patient denied a new traumatic injury, but revealed the habit of chewing on a pencil. Refraining from the deleterious oral habit was strongly advised, and root canal filling with mineral trioxide aggregate was performed to treat the root fracture. After 4 years of follow-up, the tooth has normal function and no abnormal mobility. Images suggestive of remodeling at the apical end of the coronal segment and replacement resorption of the apical segment are seen radiographically. This case demonstrates the need of following cases of dental trauma and the possible influence of parafunctional oral habits as modifying factors of case progression.
authors.affiliation: Department of Surgery and Integrated Clinic Dental School of Araçatuba, UNESP-São Paulo State University, Araçatuba, São Paulo, Brazil.
authors.forename: Cláudia Letícia Vendrame
authors.initials: CL
authors.lastname: dos Santos
authors.forename: Célia Tomiko Matida Hamata
authors.initials: CT
authors.lastname: Saito
authors.forename: Eloá Rodrigues
authors.initials: ER
authors.lastname: Luvizzuto
authors.forename: Wilson Roberto
authors.initials: WR
authors.lastname: Poi
authors.forename: Sônia Regina
authors.initials: SR
authors.lastname: Panzarini
authors.forename: Celso Koogi
authors.initials: CK
authors.lastname: Sonoda
mesh_terms: D017607:Aluminum Compounds / Q000627:therapeutic use; D056624:Apexification / Q000379:methods; D017610:Calcium Compounds / Q000627:therapeutic use; D002648:Child; D003188:Composite Resins / Q000737:chemistry; D003769:Dental Occlusion, Traumatic / Q000150:complications*; D003790:Dental Pulp Necrosis / Q000209:etiology; D003793:Dental Restoration, Permanent / Q000379:methods; D004338:Drug Combinations; D005500:Follow-Up Studies; D006801:Humans; D007180:Incisor / Q000293:injuries*; D008297:Male; D010087:Oxides / Q000627:therapeutic use; D011859:Radiography; D012387:Root Canal Filling Materials / Q000627:therapeutic use; D018915:Root Canal Preparation / Q000379:methods; D012391:Root Resorption / Q000000981:diagnostic imaging; D017640:Silicates / Q000627:therapeutic use; D019227:Tooth Apex / Q000000981:diagnostic imaging; D019228:Tooth Crown / Q000293:injuries; D014082:Tooth Fractures / Q000209:etiology* / Q000628:therapy; D014092:Tooth Root / Q000293:injuries*
chemical_list: D017607:Aluminum Compounds; D017610:Calcium Compounds; D003188:Composite Resins; D004338:Drug Combinations; D010087:Oxides; D012387:Root Canal Filling Materials; D017640:Silicates; C467914:TPH spectrum; C086631:mineral trioxide aggregate