Vertical fractures in teeth can present difficulties in diagnosis. There are, however, many specific clinical and radiographical signs which, when present, can alert clinicians to the existence of a fracture. In this review, the diagnosis of vertical root fractures is discussed in detail, and examples are presented of clinical and radiographic signs associated with these fractured teeth. Treatment alternatives are discussed for both posterior and anterior teeth.Key words: Endodontics, diagnosis, vertical fractures.(Received for publication March 1999. Accepted March 1999
IntroductionVertical root fractures have been described as l o n gitudinally oriented fractures of the root, extending from the root canal to the periodontium.
1They usually occur in endodontically treated teeth, although occurrence in non-restored teeth has been described. [2][3][4] The vertical fracture may involve the whole length of the root or only a section of it. It may involve only one or both sides of the root. [5][6][7] In molar teeth, the fracture is most commonly bucco-lingual in ori e n t ation in individual roots. Mesio-distal fractures are less common. In anterior teeth, the fractures are most commonly in a buccolingual direction.5 Vertical root fractures can be i n i t i ated from coronal tooth structure (Fig. 1) or at the apex (Fig. 2). Incomplete and complete root fractures h ave been descri b e d . 8 , 9 Most ve rtical root fractures are complete. 6 The radiographic and clinical signs of ve rtical root fractures were extensively reviewed by Pitts and Natkin in 1983.1 A number of other diagnostic reviews have been published. 7,10-13 Numerous case reports also appear in the literature describing single or multiple cases of vertical root fractures. [14][15][16][17][18][19][20][21][22][23][24][25][26][27][28] If unrecognized, vertical root fractures can lead to frustration and inappropriate endodontic treatment. Diagnosis is sometimes difficult as there is often no
Diagnosis and management of teeth with vertical root fracturesAlex J. Moule* Bill Kahler † single clinical feature which indicates that root fracture is present 11 and signs and symptoms are often delayed. Indeed, average time between root filling and the appearance of a vertical root fracture has been estimated to be between 39 months 23 and 52.5 months 29 with a range of three days to 14 years. In general, however, all vertically fractured teeth exhibit specific clinical and radiographic signs which should alert the practitioner to the possibility of a root fracture being present. This paper reviews these diagnostic features, presenting examples of each. Treatment alternatives are discussed but causes of vertical root fractures are not addressed. They will be the subject of a further review.
Clinical presentationThe clinical presentation of a vertical root fracture is extemely va riable. The clinical signs and symptoms vary according to the position of the fracture, tooth type, time after fracture, the periodontal condition of the tooth and the architecture...