The rationale behind the extraction of the tooth present in the line of fracture in the preantibiotic era was to minimize complications. Various complications like delayed union, nonunion, infection, and odontalgia were attached with such teeth. After the advent of antimicrobial drugs and rigid internal fixation, the conservative management of such teeth has been advocated.
The current evidence presented by researchers all over the world seems to be overwhelmingly in support of the conservative management of the tooth in the fracture line. The tooth involved may often be of great value in repositioning of the fracture segments and can be later on used as abutment for prosthesis placement. The extraction of such tooth may cause further trauma and compounding of the fracture thus exaggerating the attending complication and may preclude the possibility of some form of rigid fixation. We recommend a 1-year follow-up with clinical and radiological evaluation of the tooth in the line of fracture. It would be sufficient to exclude any temporary loss of vitality and avoid unnecessary endodontic intervention. Lastly, the absolute indication for the extraction of such tooth prior to fixation are non-restorable damage in the tooth substance, grade II or III mobility due to chronic periodontitis, presence of caries with periapical pathology, and displaced or extruded tooth hampering anatomic reduction.
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