(TC07) Cracks in the Foundation: Resident Case Studies on Horizontal Root Fractures with Pulp Vitality Outcomes

Horizontal root fractures present unique diagnostic and therapeutic challenges in endodontic practice, especially in distinguishing cases that can be managed conservatively from those requiring intervention. This table clinic aims to examine cases of horizontal root fractures treated at the UTHealth Houston endodontic residency clinic, with particular focus on undiagnosed fractures presenting in asymptomatic patients. Two of these cases demonstrated the preservation of pulp vitality, allowing for conservative monitoring and non-surgical management. These cases were assessed radiographically to determine the healing potential of different fracture types and locations.  In one contrasting case, necrotic pulp necessitated endodontic intervention. For this case, endodontic treatment was indicated to prevent further periapical pathology, and the patient’s prognosis and post-treatment healing response were evaluated. This clinic-based presentation emphasizes key diagnostic strategies, such as CBCT imaging, to accurately detect and classify root fractures while underscoring the importance of pulp vitality testing in guiding treatment. Radiographic and clinical follow-up for each case allow for an in-depth analysis of healing patterns, such as hard tissue formation, interposition of connective tissue, and arrest of fracture propagation. Several outcomes demonstrate maintenance of pulp vitality as a significant predictor of positive healing, while necrotic cases require targeted endodontic intervention to achieve a favorable prognosis. By comparing these distinct cases, this table clinic presentation highlights the diagnostic complexity of horizontal root fractures, provides insights into effective treatment protocols, and offers an evidence-based perspective on prognosis and long-term outcomes.