Vertical root fracture: Factors related to identification

Area of Science:

• Endodontics
• Dental Diagnostics
• Surgical Pathology

Background:

• Vertical root fracture (VRF) necessitates root removal, making accurate diagnosis critical.
• Existing diagnostic methods for VRF often yield inconsistent findings.
• This study aimed to correlate clinical, radiographic, and surgical observations for VRF identification.

Purpose of the Study:

• To evaluate the diagnostic utility of subjective, objective, and radiographic findings in identifying vertical root fractures (VRF).
• To determine the reliability of clinical presentation versus surgical visualization in diagnosing VRF.
• To characterize the intraoperative findings associated with VRF.

Main Methods:

• A case series involving 42 roots with suspected VRF was analyzed.
• Pre-operative data included symptoms, soft-tissue changes, percussion, mobility, probing depths, and periapical radiographs.
• Post-flap reflection assessment involved evaluating bony changes and root surfaces, with VRF confirmed visually post-removal.

Main Results:

• Clinical signs and symptoms of VRF were found to be inconsistent, with mild pain reported in most cases.
• Prevalence of swelling (77%) and sinus tracts (31%) was noted, alongside varied probing patterns (66% narrow-rectangular).
• Intraoperative findings consistently revealed a 'punched-out' bony lesion with granulomatous tissue (100%) upon flap reflection.

Conclusions:

• No single clinical or radiographic sign reliably indicates vertical root fracture (VRF).
• Flap reflection is a predictable method for VRF diagnosis, consistently revealing characteristic bony defects.
• Visualization of the fractured root surface, sometimes requiring root-end resection, confirms the diagnosis.