Atypical radiographic presentation of a horizontal mid-root fracture in a maxillary central incisor tooth

Prognosis of a horizontal mid-root fracture is favorable, primarily because the dental pulp tends to maintain its vitality and the fracture segments are completely intraalveolar. Healing usually occurs with deposition of calcified tissue. However, if the segment coronal to the fracture becomes nonvital and infected, healing occurs by interposition of granulation tissue. This report describes a case of a horizontal mid-root fracture in a right maxillary central incisor tooth, where the apical fractured segment was significantly displaced in a linear direction. This was attributed to the pressure generated from the expanding granulomatous tissue that was interpositioned between the fractured segments. This resulted in an atypical radiographic presentation. In addition, this report highlights the role of cone-beam computed tomography in the diagnosis, treatment planning, and management of root fractures.