A horizontal root fracture is located in the CERVICAL third of the root. What is the most appropriate treatment?

Correct answer: D. Extraction with implant or prosthetic replacement

• A. Endodontic treatment of the coronal fragment is considered for middle-third fractures where the coronal fragment becomes necrotic, but it does not solve the lack of support in a cervical fracture.
• B. Splinting is the appropriate treatment for MIDDLE and APICAL third fractures, where the fragments are stabilized and healing with calcified tissue, connective tissue, or bone and connective tissue can occur.
• C. Orthodontic extrusion is used to bring a sound fracture margin above the crest in some restorable cases, but a true cervical-third root fracture rarely leaves enough root to make this viable.
• D. CORRECT. Cervical-third root fractures carry the WORST prognosis of any horizontal root fracture. The fracture line communicates with the gingival sulcus and therefore with the oral environment, the coronal fragment has almost no remaining support, and healing across the fracture line is rare. Extraction with prosthetic or implant replacement is usually the realistic outcome.

Note: Prognosis by location, best to worst: APICAL third best — often needs no treatment at all beyond monitoring; MIDDLE third intermediate — flexible splint 4 weeks, monitor vitality, treat the coronal fragment endodontically if it becomes necrotic; CERVICAL third worst — usually extraction. Note the apical fragment almost always retains vitality and rarely requires treatment.