Treatment and preservation of horizontal fracture and necrosis in maxillary incisors: a conservative clinical case

ABSTRACT Dental trauma is caused by direct impacts to the teeth and can occur in both children and adults, affecting the teeth and surrounding structures. In this context, the objective of this study was to report a clinical case of a 26-year-old female patient who required endodontic treatment of tooth 21 due to pulp necrosis, and follow-up (monitoring) of tooth 11, which presented a horizontal root fracture in the middle third, but with preserved pulp vitality. Both conditions were associated with trauma that occurred during childhood. A discussion was conducted regarding the main aspects related to diagnosis, clinical management, and long-term follow-up. The treatment plan consisted of complete endodontic therapy for tooth 21, using specific instrumentation techniques, intracanal medication, and obturation, as well as the follow-up of tooth 11 with a focus on preserving pulp vitality and monitoring the root fracture. Clinical and radiographic follow-up was carried out over a 12-month period, with evaluation through pulp sensitivity tests, clinical examination, and periapical radiographs. At the end of this period, tooth 11 maintained a positive response to sensitivity testing and showed no clinical signs of failure, while tooth 21 showed regression of the periapical lesion and absence of symptoms, indicating the success of the conservative treatment adopted. It is concluded that the management of patients with root fractures requires a thorough diagnostic approach, considering the degree of pulp and periapical involvement, and that long-term follow-up is essential to monitor potential late changes, ensuring treatment success and the maintenance of function and aesthetics of the affected tooth.