A Novel Surgical Treatment Approach for Vertical Root Fractures of Endodontically Treated Molars: A Report of 3 Cases

Background: Vertical root fracture (VRF) is a severe complication of endodontically treated teeth with a poor prognosis. Despite many tentative tooth-preserving approaches, the current main treatment remains tooth extraction or root resection, which is largely due to the difficulty in balancing the mechanical strength for fracture fixation and biological properties for periodontal healing. Moreover, all documented reports regarding VRF repairing so far were limited to anterior teeth and premolars. Thus, the objective of this case report was to present a novel surgical treatment approach for repairing VRF of molars. Methods: Three patients (2 females, 1 male; aged 30-33 years) with endodontically treated molars (Tooth #46, #16, #37) diagnosed with VRF were treated with a dual-layered repair approach with modified fracture lines and retention forms through intentional replantation. Results: After 18, 21, and 36 months of follow-up, respectively, all three cases showed no clinical symptoms, normal tooth mobility and periodontal probing, as well as reduced periradicular radiolucency on radiographs. Root resorption or ankylosis was not observed. Conclusions: The novel surgical treatment approach demonstrates effectiveness in preserving endodontically treated molars with VRF, but its long-term treatment results for various VRF of molars need further randomized and controlled clinical investigations.