GOOD MORNING

VERTICAL ROOT FRACTURE

 Longitudinal fracture confined to the root that usually

begins on the internal canal wall & extends outward to the root.
OOOOE 1999 Apr;87;4:504-7

CLASSIFICATION

Features of VRF: Begins internally & grows outward to the root surface.

Primarily in faciolingual plane.

Features of VRF: Either short or extend the length of the root from apex

to cervical portion.

May begin at the apex or the mid-root.

Diagnosis
A. Dental History B. Visual Examination C. Bite Challenge Tests D. Periodontal Probing

E. Transillumination
F. Staining G. Radiographic Examination H. Exploratory Surgery
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Dental history
H/O repeated occlusal adjustments with only temporary

relief of symptoms or evaluation by several practitioners

with inconclusive diagnosis.
H/O periodontal disease with extensive bone loss in the

area.
H/O other cracked teeth.

Visual Examination
Start with the face, checking for enlarged jaw muscles.
Check for wear facets, which may indicate a history of

clenching, bruxism, or biting and chewing with excessive

force.
Check the teeth for tight cusp-fossae relationships that

may cause excessive occlusal stresses.

Check tooth surfaces carefully in a dry field. Any craze

lines or darker cracks.

Enhanced Magnification and Illumination can be helpful in

visual identification of a crack.

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Bite Tests
Use a rubber wheel, wood stick, or other

instrument to focus biting pressures on specific cusps to reproduce the patient's complaint.
Pain during biting or chewing is considered a

classic symptom and may be the only conclusive evidence early in the crack's development.

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Staining
Cracks may be disclosed through staining

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Transillumination
A fiberoptic or other similar light source is applied

directly to the tooth surface.

The light beam is positioned perpendicular to the

plane of the suspected crack.

A crack will block the light.

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Radiographic advances: Tuned aperture CT.

Conventional axial CT. Optical coherence tomography. Cone beam computed tomography.

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Radiographic advances: Computed Tomography is superior to dental radiography in

the detection of dental vertical root fractures.

(Radiology :February 1999)

Cone beam computed tomography have been applied to

detect vertical root fractures, which proved to be a valuable tool in the detection of the same.
(CJDR Vol. 13, No. 1, 2010)

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Aim of TREATMENT
Eliminate fracture line. Remove granulation tissue. Tissue repair. Placement of fracture line on sound bone.
(in cases of replantation).

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TREATMENT
Bonding
Tissue repair Surgical approach Extraction

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Bonding

Tissue repair

Surgical approach

Cynoacrylate
Lasers Photocured resin liner

Calcium
hydroxide Gore-Tex

Hemisection
Root resection Amputation

membrane

Cynoacrylate
Technique consisted of : Extraction of all fractured segments. Completion of all endodontic procedures extraorally. Recementation of segments with cyanoacrylate. Replantation with ligation within 30 min.
(J Endod 1984;10:391-396)

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Lasers
Multiple passes along the line of fracture. It was inspected using a dissecting microscope after each

pass until a visual indication of fusion or irreparable

damage resulted.
(J Endod 1996;22:662-667)

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Lasers
SEM revealed:
Heat-induced fissures and cracks.
Areas of cementum meltdown and resolidification.

Crater formation.
Separation of cementum from underlying dentin.

(J Endod 1996;22:662-667)

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Bands
T his is a report of the treatment and prognosis of a maxillary

second milar exhibiting a complete vertical crown-root fracture. The buccal and palatal segments were widely separated by as much as 2 mm and were immobile.. This was accomplished by application of orthodontic elastics to the tooth crown in combination with a wire splint. After approximately 1 month of continuous use of the orthodontic elastics, the dislodged segments were suitably repositioned close to their original positions. The tooth was then endodontically treated and restored with a case complete crown. The restored tooth has become functioning well, with periodic periodontal maintenance, for more than 3.5 years, indicating a promising prognosis.6:479-484.)
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TISSUE REPAIR
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Fracture cleaning, bonding of the fracture,

placement of a bone graft material and

application of guided-tissue regeneration.
(J Endod 1996;22:426-429)

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The segments were extracted separately.

They were bonded with the use of a biocompatible glass ionomer bone cement. Replanted in conjunction with a polytetrafluoroethylene (GORE-TEX) membrane.
(J Endod 1992;18:460-463)

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Use of calcium hydroxide paste to induce

healing of fractured roots. Glass-ionomer cement was used as a root canal sealer and then condensed into the root canals to bind the segments together.
(Quintessence Int 1991;22:707-709.)

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Surgical Approach

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Hemisection

IJCD, March 2011;2(2).

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Hemisection

IJCD, March 2011;2(2).

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Hemisection

IJCD, March 2011;2(2).

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CASE 1

Dent Traum 2002; 18: 4245

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CASE 1

Dent Traum 2002; 18: 4245

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CASE 2

Dent Traum 2003; 19: 115117

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 An incomplete buccolingual vertical fracture

developed in the root of a maxillary left second premolar.

Removal of a major portion of the buccal half of the

root and the application of a 20% citric acid solution

for 5 min, produced a favorable result.

(J Endod 1978;11:126-131.)

In

light of the treatment options reported and Retention of the tooth against
Extraction & Replacement.

available, clinician must weigh the desirability for

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Selden HS. J Endod 1996;22:426-429.

Trope M. J Endod 1992;18:460-463.

Barkhordar RA. Quintessence Int 1991;22:707-709. Takatsu T. Quintessence Int 1995;26:479-484. Arakawa S. J Endod 1996;22:662-667. Dental Traumatology 2002; 18: 4245. Dental Traumatology 2003; 19: 115117. IJCD, March 2011;2(2).

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