A horizontal root fracture is identified in the CERVICAL third of a maxillary central incisor. What is the treatment of choice?

Correct answer: B. Extraction and replacement, commonly with an implant-supported restoration

• A. Vital pulp therapy does not address a root fracture.
• B. CORRECT. Prognosis for horizontal root fracture is inversely related to how CORONAL the fracture line is. A CERVICAL-third fracture leaves a short, mobile coronal segment that communicates with the gingival sulcus and the oral environment, so bacterial contamination is essentially inevitable and healing does not occur. These teeth have the poorest prognosis and usually require extraction, with implant placement or a fixed prosthesis, unless the segment can be salvaged by orthodontic extrusion or surgical crown lengthening.
• C. Endodontic treatment cannot address the fundamental problem of an unsupported, contaminated, mobile coronal fragment.
• D. Splinting and observation is the correct approach for APICAL and MIDDLE third fractures, which have a good prognosis with a rigid or flexible splint for 4 weeks (up to 4 months for cervical-third cases per IADT).

Note: IADT: apical third = best prognosis; middle third = good; cervical third = poorest. The more coronal the fracture, the worse the outlook.