Root Fracture — ORE Part 1 MCQ

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ModerateOral SurgeryRoot FractureORE Part 1

Following trauma, a permanent lower premolar has a root fracture in the apical third. The coronal segment is slightly mobile and tender to percussion. Pulp sensibility testing is positive and the tooth is not displaced. What is the most appropriate immediate management?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: D — Apply a flexible splint for 4 weeks and review pulp status

Explanation lettering: B = shown as A · C = shown as B · D = shown as C · A = shown as D

A is correct. A permanent tooth with a root fracture and a mobile coronal segment should be stabilised using a passive flexible splint for 4 weeks, with clinical, radiographic and pulp follow-up. A positive sensibility response means immediate root canal treatment is not indicated; treatment is required later only if the coronal pulp becomes necrotic. Extraction is unnecessarily destructive for an apical-third fracture, which generally has a favourable prognosis. Observation without stabilisation fails to manage the mobility and may compromise healing. A rigid splint for 8 weeks is not recommended: splinting should be flexible, and prolonged splinting is reserved for cervical root fractures rather than an apical-third fracture.

Reference: Bourguignon C, et al. International Association of Dental Traumatology guidelines for the management of traumatic dental injuries: 1. Fractures and luxations. Dental Traumatology. 2020;36:314-330. https://pubmed.ncbi.nlm.nih.gov/32475015/