How are vertical root fractures managed?
Sandhya Anand Khasnis, Krishnamurthy Haridas Kidiyoor, Anand Basavaraj Patil, and Smita Basavaraj Kenganal
- Vertical root fractures associated with endodontically treated teeth and less commonly in vital teeth represent one of the most difficult clinical problems to diagnose and treat. In as much as there are no specific symptoms, diagnosis can be difficult.
- Clinical detection of this condition by endodontists is becoming more frequent, where as it is rather underestimated by the general practitioners.
- Since, vertical root fractures almost exclusively involve endodontically treated teeth; it often becomes difficult to differentiate a tooth with this condition from an endodontically failed one or one with concomitant periodontal involvement.
- Also, a tooth diagnosed for vertical root fracture is usually extracted, though attempts to reunite fractured root have been done in various studies with varying success rates.
Purpose of the Review
This review adds to the preventive measures which can be incorporated during routine clinical procedures and the article focuses on the diagnostic and treatment strategies, and discusses predisposing factors that can be useful in the prevention of vertical root fractures.
- CBCT can be valuable in the diagnosis and treatment of vertical root fracture, after the routine clinical and radiographic examination.
- It is essential to determine the necessity of a post in endodontically treated teeth:
- For maxillary incisors with only access cavities no posts are required.
- For posterior teeth with sufficient tooth structure remaining after tooth preparation, posts are not required.
- A post and core may help prevent coronal fractures, when the remaining coronal tooth structure is very thin after tooth preparation.
- Among the posts, threaded posts cause highest strain and incidence of root fracture.
- Parallel sided, serrated posts cause highest success rate. (1) Posts when indicated should be passive, and use of fiber reinforced composite posts should be considered whenever possible.
- Complete coverage restorations are necessary in case of endodontically treated posterior teeth except when the destruction is limited only to access cavity.
- More flexible and less tapered finger spreaders are safer than stiff, conventional hand spreader. (2)
- Root strength can be improved by removing the smear layer in case of fiber posts. (3)
- Resin based sealers like AH-26 can be used to strengthen root canal. (3) Over flared root canals which are more susceptible to vertical root fracture can be reinforced by MTA rather than gutta-percha, resilon or composite. (4, 5)
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- Tsurumachi T, Kakehashi Y. Autotransplantation of a maxillary third molar to replace a maxillary premolar with Vertical root fracture. Int Endod J. 2007;40:970–8.
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- Agarwal VS, Kapoor S, Shah NC. An innovative approach for treating vertical root fracture of mandibular molar-hemisection with socket preservation. J Interdiscip Dent. 2012;22:141–3.