Abstract
Background : Although uncommon, horizontal root fractures (HRFs) of permanent teeth represent complex traumatic dental injuries that may compromise pulp vitality and, in some cases, lead to tooth loss. Consequently, these injuries can negatively affect esthetics and the psychological development of young patients. Appropriate case-specific management and regular follow-up are therefore essential.
Aim : This paper aims to describe the management and longitudinal outcomes of transversely root-fractured permanent teeth with both mature and immature apices through the presentation of two clinical cases.
Case Description : This report presents the management of two cases of horizontal root fractures. The first case involved a 13-year-old girl with a history of a domestic accident who presented to our department one month after the injury. Clinical and radiographic examinations confirmed a horizontal root fracture of tooth 21. The delayed presentation contributed to the development of type IV healing, accompanied by a chronic abscess at the fracture line. Endodontic treatment of the coronal fragment, followed by root canal obturation with a bioactive material, altered the healing pattern from the least favorable type to a more favorable outcome.
The second case involved a 7-year-old patient who presented one hour after a school-related accident. Clinical and radiographic examinations revealed horizontal root fractures of both maxillary permanent central incisors. The fracture line was located at the junction of the apical and middle thirds in tooth 11 and at the mid-root level in tooth 21. Management strategies and healing outcomes differed between the two teeth, underscoring the critical role of pulp vitality in the healing of horizontal root fractures. Both patients remain under regular clinical and radiographic follow-up.
Conclusion : Pulp vitality, in conjunction with a healthy periodontium, plays a pivotal role in the healing of transverse root fractures. The management of these injuries should be guided by multiple factors, including the stage of root development and the location of the fracture line. Long-term follow-up is essential for the early detection and management of potential complications.

Key words: horizontal root fracture, permanent incisors, immature teeth, mature teeth, traumatic.