Vertical root fracture diagnosis in endodontically treated teeth

Abstract

Annotation. Timely diagnosis of vertical root fractures is a big challenge to dentists, because there are no specific clinical signs, symptoms and X-ray features. The aim of the research is to study clinical cases of vertical root fractures in endodontically treated teeth and to carry out analysis the methods of their diagnosis, clinical features and radiological characteristics. In patients aged 40-65 years, 34 clinical cases of vertical root fracture are considered. The main and additional methods of patients’ examination are analyzed. The statistical calculation of the obtained results is performed by the method of variation statistics with the determination of the Student’s t-test using computer programs Microsoft® Excel 2017 and “Statistica 6.1”. Clinical symptoms and abnormal findings during examination were recorded but not subjected to statistical analysis. Clinical examination revealed periodontal swelling or abscess in 6 patients, isolated narrow and deep periodontal pocket in 24 patients, low localized fistula in 9 patients. Radiological results: only in 6 clinical cases a vertical fracture line was observed on intraoral X-ray images; in 30 cases the destruction of bone tissue in the periapical area, mainly in the halo-type radiolucency was determined; in 4 cases no pathological changes in periapical bone tissue were revealed. Vertical root fracture was confirmed by muco-periosteal flap detachment in all cases. It has been established that a number of signs, namely: isolated deep narrow periodontal pocket; coronally located fistula; characteristic bone destruction (J-shaped or “halo” radiolucency) on the radiograph indicate the likelihood of vertical root fracture. Signs of fenestration of the bone adjacent to the fractured root and visualization of the fracture line after mucoperiosteal flap surgery are pathognomonic.

Diagnosis of Internal Root Resorption: Clinical Manifestations and Radiological Features

“…In internal replacement resorption, the loss of intraradicular dentin is usually accompanied by the deposition of metaplastic bone or cementum-like hard tissue instead of dentin in the resorption lesions [19]. Internal root resorption may progress and potentially lead to root perforation/fracture [13], contributing to the formation of lateral or periodontal lesion [12] or apical periodontitis [14,23] when the entire root canal system is infected with microorganisms.…”

“…Internal root resorption can develop rapidly, destroying the tooth in a few months, or may last for years without pronounced pathological activity [7,12]. A gradual increase of defect sizes leads to a root fracture, and, accordingly, to the fragments removal [13]. In the diagnosis of internal root resorption in the absence of clinical symptoms, traditional radiography and cone beam computed tomography (CBCT) occupy a prominent place [2,6,11].…”