Contributor

Prof. A. Tamse

Country –institution

The Maurice and Gabriela Goldschleger
School of Dental Medicine / Tel Aviv University / Israel

Title

Summary

The vertical root fracture (VRF) initiates in the root, propagates coronally and is usually in a bucco-lingual plane. The fracture can be incomplete - extends from the root canal space to one side of the root or complete - to both buccal and lingual surfaces.

VRF in an endodontically treated tooth is a frustrating phenomenon, both for the patient and the dentist. When diagnosed, usually years after completion of all the procedures in the tooth, it is then necessary to extract the tooth or the root.

The clinical and radiographic diagnosis should be made quickly and accurately. When the fracture line from the root exceeds the gingival margin, the buccal bone resorbs rapidly. The large amount of bone loss complicates future restorative treatment, such as implant placement. It was often difficult to achieve a fast and accurate diagnosis of VRF in susceptible teeth (maxillary and mandibular premolars) and roots (mesial root of mandibular molars) because clinical signs, symptoms, and radiographic bone radiolucencies resemble either a periodontal problem, or those of root canal treatment failures. As well, probably more than one etiology exists and there is a natural tendency to delay treatment, i.e., extraction.

            Recently, both retrospective clinical studies and the development of new clinical aids, such as the operating microscope, indicate some typical signs and radiographic features that could help the clinician to make a quick and accurate diagnosis. These include probing defect mainly on the buccal side, sinus tract closer to the gingival marginbone destruction during exploratory flap procedure, "Halo" and lateral side bone radiolucencies around the premolars and mesial root of the mandibular molars, and in the latter, also bifurcation bone destruction. than to the apical location, typical