The Silent Fracture: Incidental CBCT Detection of a Non-Traumatic Oblique Palatal Root Fracture in a Vital Maxillary...

Root fractures of maxillary molars, particularly those involving the palatal root, are rarely reported and often present diagnostic challenges due to their deep anatomical position and lack of overt clinical symptoms. Most cases are associated with trauma; however, nontraumatic etiologies, including chronic occlusal stress and dietary habits, may also contribute. A 57-year-old Iranian female with no history of trauma or systemic disease was referred for endodontic evaluation of the maxillary first molar due to extensive caries and a separated instrument fragment. Cone-beam computed tomography (CBCT), performed for diagnostic clarification, incidentally revealed an oblique palatal root fracture in the adjacent intact maxillary second molar (Tooth #15). The fracture line extended obliquely from the furcation area toward the apical third of the palatal root. The tooth remained vital, asymptomatic, and clinically stable, with normal probing depths and intact surrounding soft tissues. Conservative management through observation and periodic radiographic monitoring was adopted. At the 8-month follow-up, the tooth remained asymptomatic and responsive to vitality testing, with no clinical or radiographic evidence of periodontal or periapical pathology. This case highlights the diagnostic value of CBCT in identifying asymptomatic root fractures that may remain undetected on conventional radiographs. It expands the etiological understanding of root fractures to include repetitive masticatory microstresses potentially associated with dietary habits such as the consumption of hard traditional foods (e.g., Tah dig). Accurate diagnosis requires clinical expertise, careful examination, and the use of advanced imaging modalities. To the best of our knowledge, this is the first report of an incidentally detected asymptomatic oblique palatal root fracture in an Iranian patient. The case underscores the importance of clinician awareness, comprehensive imaging assessment, and conservative management for preserving pulp vitality and long-term tooth function.