Does a tooth with a horizontal root fracture always need to be removed?

I have been practicing dentistry in Manhattan for over thirty years and  I have looked at a number of radiogpraphs of anterior teeth with horizontal root fractures that are relatively asymptomatic.  This seems to be the case especially when the fracture occurs more apically and is not close to the crestal bone. Many of these teeth remain in my patients mouths for years with little or no deterioration of the bone surrounding the fractured root.

These teeth do have a guarded prognosis and may become infected. Also they can over time become increasingly mobile. If they become infected or show increased mobility, they should be removed before the surrounding bone becomes too compromised for implant placement. Also they are not good candidates to use as abutments for bridges and may be electively removed if a comprehensive restorative treatment plan for the area is contemplated.