A child sustains a horizontal root fracture in the APICAL third. The tooth is asymptomatic, not mobile, and responds normally to pulp testing. What is the appropriate management?

Correct answer: B. Monitor with periodic clinical and radiographic review

• A. Extraction is unwarranted for a stable, vital, asymptomatic tooth.
• B. CORRECT. Apical-third root fractures have the BEST prognosis of any root fracture. The coronal segment retains a substantial periodontal attachment, so there is little mobility, and the pulp usually survives. With no symptoms, no mobility and a vital pulp, the correct treatment is observation — review at 4 weeks, 6–8 weeks, 4 months, 6 months, 1 year and annually thereafter.
• C. Prophylactic endodontic treatment of a vital, asymptomatic tooth is unnecessary and would itself risk complications. Treat only if necrosis develops, and then only the CORONAL segment.
• D. Splinting is reserved for MOBILE fractures, and applies to cervical and middle-third fractures. This tooth is not mobile.

Note: Prognosis improves the more APICAL the fracture. Cervical-third fractures are the worst, since the coronal fragment has minimal support and the fracture line communicates with the sulcus.