Authors: Pitts DL, Natkin E.
Title: Diagnosis and treatment of vertical root fractures.
Journal: J Endod
Date: Aug 1983
Citation: 9(8):338-46
Category: Diagnosis and Case Selection
Evidence-based Ranking: 5
Purpose/Objectives: To discuss characteristics of vertical root fractures and factors useful in detection and determination of their extent. Treatment alternatives are presented.

Diagnosis: Vertical root fractures are often definitively diagnosed by inspection at time of surgical exposure. Because of difficult radiographic access, exposure often corroborates a suspected diagnosis. Common signs – radiolucency, swelling, sinus tracts, percussion sensitivity, and mobility may be associated with other endodontic and periodontic pathosis.

Radiographic signs: Actual separation of root fragments or fracture lines can be conclusive or suggestive evidence. If radiopaque filling material extrudes into a fracture line it may appear on an x-ray. A halo-like radiolucency, especially if it involves two opposite sides of a root are suggestive for fractures. Periodontic bone lesions – narrow, step-like in shape, angular in appearance are suggestive of root fractures. Resorption along the fracture line and loosened retro-fillings suggest possible root fracture.

Clinical signs: At the time of root filling - sharp cracking or popping sounds maybe heard, the patient may feel a sharp stab of pain, pain with continued condensation and or bleeding into the canal, all which indicate a possible fracture. Narrow, rectangular periodontal pockets, essentially sinus tracts, have a characteristic feel when probed – different from crater-like defects of chronic periodontitis – and may suggest a vertical fracture. Visualization maybe possible if the gingiva can be retracted slightly or has receded. Dark staining or a clicking when explored may indicate a fracture line. Transillumination may help visualize. Surgical exposure and use of dyes confirm a vertical fracture.

Treatment: The aim is to eliminate the fracture. Depending on the size and location, treatment ranges from partial root resection to extraction. If suspected, surgery should be planned accordingly. Partial root resection especially in the anterior teeth, and hemi-sections in posterior teeth can be successful.