Background: A horizontal root fracture features a fracture line perpendicular or oblique to the root's long axis, affecting less than 3% of dental injuries. Classification, diagnosis, and prognosis depend on the root's developmental stage, the number and location of fracture lines, and fragment displacement. This case report discusses the clinical and radiographic findings of two successfully managed horizontal root fractures in maxillary incisors using different treatment approaches.

Methods: A 16-year-old boy who had a motorcycle accident 4 months ago was referred to us with a tooth abscess. Both right and left central incisors showed a fracture line at the junction of the middle and apical thirds without dislocation. Based on the condition of the pulp in each tooth, two different treatment options were recommended. The left incisor was non-vital, had intra oral swelling and a draining sinus tract; therefore, it was treated endodontically with an MTA plug , gutta-percha, and sealer. In contrast, the right incisor was vital, and the treatment plan for this tooth was simply to monitor its vitality. Both teeth were monitored clinically and radiographically over the course of one year. Success was assessed by the absence of pulpal and periapical inflammation, as well as the presence of a functional and healthy periodontium along the fracture lines of both fragments, despite the differing treatment plans.
Conclusion: This case report underscores the importance of performing an intraoral clinical examination, as well as vitality and periradicular tests, in conjunction with radiographic evaluation whenever a root fracture is detected.