Diagnosis and Managment of Maxillary Incisor with Vertical Root Fracture: A Clinical Report with Three-Year Follow-Up

Abstract

According to the American Association of Endodontists, “a ‘true' vertical root fracture is defined as a complete or incomplete fracture initiated from the root at any level, usually directed buccolingually.” Vertical root fracture (VRF) usually starts from an internal dentinal crack and develops over time, due to masticatory forces and occlusal loads. When they occur in teeth, those types of fractures can present difficulties in diagnosis, and there are however many clinic and radiographical signs which can guide clinicians to the existence of the fracture. Prognosis, most often, is hopeless, and differential diagnosis from other etiologies may be difficult sometimes. In this paper, we present a case of VRF diagnosed after surgical exploration; the enlarged fracture line was filled with a fluid resin. A 36-month clinical and radiological follow-up showed an asymptomatic tooth, reduction of the periodontal probing depth from 7 mm prior to treatment to 4 mm with no signs of ankylosis. In this work, the diagnosis and treatment alternatives of vertical root fracture were discussed through the presented clinical case.

New approach for the treatment of vertical root fracture of teeth: A case report and review of literature

“…Factors that may affect the prognosis of VRF treatment include the reattachment of periodontal tissue, alveolar bone regeneration, proper sealing of the fracture line, and prevention of refracture. The use of adhesive composite resin has been widely reported in the literature for the treatment of VRF[ 4 - 6 , 19 - 23 ]. The ideal bonding and repair material for VRF should have the following features to allow periodontal tissue attachment: sufficient fixation strength, short setting time, easy application, hydrophilicity, bacteriostaticity, and biocompatibility[ 24 ].…”

“…Vertical root fracture (VRF) is a longitudinally oriented fracture of the root and can be classified as an incomplete or complete VRF based on the degree of separation of the fragments according to Leubke’s classification[ 1 - 4 ]. VRF is a serious complication with poor prognosis in endodontically treated teeth.…”

“…The overall prevalence of VRF reported in retrospective studies is 3%–5%, but the prevalence of VRF in endodontically treated teeth is approximately 3.69%–25%[ 1 , 3 ]. Even if extraction is usually the first choice of management for teeth with VRF, various other methods to preserve the teeth have also been described in many case reports, such as using adhesive composite resin[ 4 - 6 ], CO 2 and Nd:YAG laser[ 7 ], mineral trioxide aggregates (MTAs)[ 8 , 9 ] and biodentine[ 10 , 11 ].…”