Vertical root fracture: Factors related to identification.

BACKGROUND: Vertical root fracture (VRF) requires root removal. Diagnostics for proper identification are critical. The author conducted a study to relate subjective, objective, and radiographic findings for VRF identification. They noted visual changes of root and overlying bone patterns after flap reflection.

METHODS: The author examined a case series of roots with suspected VRF after flap reflection and root or root-end removal; 42 roots were identified with a fracture. Before reflection, the author obtained diagnostic and periapical radiographic data that included symptoms, soft-tissue changes, percussion, mobility, probing patterns, and radiographic findings. After flap reflection, the author evaluated bony changes and root surfaces. VRF was visually confirmed after tooth or root removal.

RESULTS: Signs and symptoms diagnostic of VRF were inconsistent. All patients had endodontic therapy, many with posts, and for all patients, the pain was none to mild. In addition, the author found a history or presence of swelling (77%) or sinus tract (31%), that probing patterns differed (narrow-rectangular 66%), and that there was no defect in some patients (21%). Radiographic patterns varied from no change to extensive bone loss, and mobility ranged from none (55%) to slight or moderate (45%). Flap reflection revealed a "punched-out" bony lesion with granulomatous tissue (100%), and patterns were fenestration (21%) or dehiscence (79%). A fracture was visible on roots or resected root ends.

CONCLUSIONS: The author found no consistent signs, symptoms, or radiographic changes of VRF. Flap reflection was found to be predictably useful; fractured roots had bony defects filled with granulomatous tissue.

PRACTICAL IMPLICATIONS: VRF may be suspected from clinical findings; however, flap reflection is usually required for identification. Characteristic bony pattern and root visualization reveals the fracture, although root-end resection and examination is occasionally required.