The detectability of VRFs by CBCT in vitro and in vivo was dependent upon fracture width. The accuracy of CBCT in detecting VRFs of 50-300 μm width in vivo was significantly lower compared to the in vitro accuracy.

Aim To compare the in vivo accuracy of CBCT for the detection of fracture lines versus the diagnosis of vertical root fractures (VRFs) according to characteristic patterns of associated bone resorption. Methodology Eighty‐eight patients with symptoms typical of VRFs in root filled teeth, who underwent a CBCT examination and later had the teeth extracted, were divided into two groups: the fracture group (n = 65) and the control group (n = 23). Five blinded observers assessed the CBCT images in two sessions. During the first session, they were asked to state the diagnosis according to the CBCT and clinical data. During the second session after 2 weeks, they assessed only axial slices and were asked to detect a fracture line. The mean CBCT specificity, sensitivity, accuracy values and area under the receiver operating characteristic (AUROC) curve were calculated and compared using the Wilcoxon signed‐rank test. Results The average sensitivity of CBCT for the diagnosis of VRFs was 0.84 ± 0.2. The accuracy and AUC values were 0.81 ± 0.08 and 0.84 ± 0.17, respectively. The sensitivity, accuracy and AUC values for the detection of VRFs were significantly lower: 0.17 ± 0.24 (P = 0.042), 0.54 ± 0.07 (P = 0.043), and 0.52 ± 0.09 (P = 0.043), respectively. The specificity of CBCT for the detection and diagnosis of VRFs did not differ significantly (P = 0.50). Conclusion Cone‐beam computed tomography was helpful in VRF diagnosis even when it was not possible to visualize the fracture line.

Objectives: To compare the accuracy of cone-beam CT ex vivo and in vivo for the detection of artificially created large and small vertical root fractures in extracted teeth restored with post-core. Methods: Individual metal cast post-cores were fixed in the root canals of 50 extracted single-rooted human teeth. In 30 teeth fractures were created by tapping posts with a hammer. The teeth were sterilised in autoclave and embedded into bite-plates made of silicon impression material. Cone-beam CT scanning was performed ex vivo and in vivo . For the in vivo scanning, teeth in sterile plastic bags were inserted into the mouths of volunteers. Then the teeth were sectioned with low-speed saw and the widths of the VRFs were measured microscopically. The teeth were distributed into 2 groups in accordance with the measured fractures’ widths: large (wider than 180–250 µm) and small (80–150 µm). Five observers assessed the presence of vertical root fractures on axial CBCT slices. Sensitivity, specificity, accuracy and inter examiner agreement were calculated. Results: The accuracy of cone-beam CT in vitro for large and small vertical root fractures detection was 0.56 and 0.40 respectively (p = 0.043). The sensitivity values were 0.53 and 0.27 for large and small vertical root fractures, respectively (p = 0.043). The visualisation of fracture lines in vivo was impossible in 90 % of cases, because of low image quality. Inter examiner reliability analysis showed κ values ranging from 0.02 to 0.54. Conclusions: Fracture width affected the in vitro detectability of vertical root fractures by cone-beam CT in teeth with metal cast post-cores. The detectability of root fractures in vivo was decreased because of low image quality, making the assessment of sound tooth tissue impossible.

The pulp and periodontium have obvious relationships that have been described in many studies. Pulp infections may affect periodontal tissues and vice versa. Teeth with endo-perio lesions have a worse prognosis than isolated endodontic or periodontal lesions. Elimination of endodontic and periodontal infections is essential for successful treatment, so co-operation between endodontists and periodontists is necessary. In this clinical case, a 44-year-old male presented with primary periodontal disease with secondary endodontic involvement in his lower right canine because of aggressive periodontitis. There was 10 mm of clinical attachment loss and 8 mm periodontal pocket mesial from the tooth and bone radiolucency periapical and lateral from the root. Periodontal therapy was followed by endodontic treatment. Periodontal therapy included root scaling and planing, treatment of the periodontal pocket with ozone gas, systemic antibiotics, oral hygiene instructions, and chlorhexidine rinsing. Endodontic therapy included root canal instrumentation with rotary endodontic files, irrigation, root canal treatment with ozone gas, and obturation with lateral compaction. Radiographs at a 6-month follow-up appointment showed complete healing of the periapical lesion and alveolar bone lateral to the root. Using an interdisciplinary approach to treat endo-perio lesions provides favorable clinical outcomes. Ozone therapy is beneficial for the successful treatment of endo-perio lesions with narrow periodontal pockets in patients with aggressive periodontitis and poor prognosis.

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Dentists prefer macrolide antibiotics, protected penicillins, and fluoroquinolone combined with 5-nitroimidazole. All patients have taken antibiotics themselves at least once a year. Microbial complexes in patients with acute and exacerbated apical periodontitis in 79% of cases are susceptible to amoxicillin/clavulanic acid, to azithromycin - 52%, lincomycin - 36%, 5-nitroimidazole - 68%, ciprofloxacin - 73.7%. In patients with apical abscess high rates of resistance of microbial complexes to all types of antibiotics was revealed (33% for lincomycin 76,1% for ciprofloxacin, 28,6% for 5-nitroimidazole). Patients with moderate to severe periodontitis in 90.5% are sensitive to amoxicillin/clavulanic acid and azithromycin, in 62.4% to lincomycin. Sensitivity to ciprofloxacin was detected in 85.7% of patients, in 14.3% - moderate resistance.

The review sought to describe the main risk factors for vertical root fracture predisposition in teeth after root canal treatment: altered mechanical characteristics of dentine due to loss of moisture and use of aggressive irrigation agents, insufficient amount of remaining dentine tissue after mechanical preparation of root canals, damage to the remaining tooth structure due to the effects of posts of different materials. According to the reviewed studies it is difficult to reveal the main factor predisposing to vertical root fractures. It is likely that in each case there is an interaction of several factors.

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