What is the treatment for a fractured stump?

Treatment of a Fractured Stump

For a fractured residual root or tooth stump, leave the fragment in place and monitor for natural resorption if removal risks damage to vital structures; extract only if the fragment becomes mobile with aspiration risk, develops infection, or is located near the crown with poor prognosis. 1, 2

Initial Assessment

• Obtain radiographic examination immediately to confirm the location of the root fracture and assess proximity to vital structures (permanent tooth buds in children, neurovascular structures) 1, 2
• Evaluate the level of the fracture: fractures closer to the root apex have excellent prognosis, while those near the crown have poor prognosis 1, 3, 2
• Assess crown mobility and aspiration risk—if the crown segment is excessively mobile, immediate referral is indicated 1

Treatment Algorithm Based on Fracture Location

Root Fracture Near Apex (Good Prognosis)

• No treatment required in most cases—these fractures rarely need intervention 1, 2
• Monitor the fragment for natural resorption over time 1, 2
• Schedule regular follow-up until complete resorption or exfoliation 1

Root Fracture Near Crown (Poor Prognosis)

• Remove the crown segment if it is mobile or symptomatic 1
• Attempt extraction of the root fragment only if it can be removed safely without damaging underlying permanent tooth buds or vital structures 1
• If removal poses risk to developing permanent tooth buds, leave the residual root and monitor for natural resorption 1, 2

Alveolar Fracture with Segment Mobility

• Reposition the displaced segment immediately and stabilize with a splint 1, 4
• This applies when multiple teeth move together as a unit due to alveolar bone fracture 1

Monitoring Protocol

Monitor all retained root fragments for signs of pulpal necrosis until natural resorption occurs: 1, 2

• Crown discoloration 2
• Gingival swelling or sinus tract formation 2
• Increased tooth mobility 2
• Pain or tenderness to percussion 1

Indications for Immediate Intervention

Extract the root fragment immediately if: 1, 2

• The fragment becomes mobile with risk of aspiration 1, 2
• Clinical signs of infection develop (abscess, cellulitis, purulent drainage) 2
• Pathology develops around the retained fragment on radiographic follow-up 2
• The patient cannot cooperate with conservative monitoring 3

Pain Management

• Use NSAIDs (ibuprofen) as first-line treatment for any discomfort 3, 2
• Acetaminophen is an acceptable alternative 3
• Apply cold compresses to reduce swelling 3
• Recommend soft diet for 10 days post-injury 4, 3
• Avoid temperature extremes with food and beverages 3

Common Pitfalls to Avoid

• Do not attempt aggressive extraction of root fragments near permanent tooth buds in children—this can damage the developing tooth and cause permanent dental problems 1
• Do not assume all root fractures require extraction—most apical fractures heal without intervention 1, 2
• Do not delay referral to a dentist when crown mobility suggests aspiration risk—this is an emergency situation requiring immediate specialist evaluation 1
• Ensure radiographic confirmation that the tooth fragment was not aspirated if not found clinically—chest radiograph may be indicated if breathing difficulties are present 1