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Vertical Root Fractures in Endodontically Treated Teeth : A Clinical Survey

Vertical root fracture of endodontically treated tooth is a frustrating complication that leads tooth to extraction. The aim of this study was to evaluate clinical and radiographical findings in endodontically treated and restored teeth with the vertical root fractures. During a three year period the authors examined 50 patients with 53 root-canal-treated teeth with vertical fracture. During study the existence of vertical root fracture, the type of root canal therapy, the type of coronal restoration, the type, length of the post and the height of the tooth coronal part were evaluated. In 60.4 % of all studied cases with vertically fracture were premolars, 22.6 % constituted incisors followed by molars 13.2%. Thirty seven vertically fractured teeth out of 53 (70%) served as bridge abutment, 16 (30%) vertically fractured teeth were restored with single restoration. Cast posts, screw posts, amalgam or composite cores were observed in 43 teeth out of 53 (81 %). In 38 cases out of 43 (88,4%) filling material or post was ending at the coronal third of the root canal. The mean of the length of the post was 4.1mm (SD±1.5), while the mean of the height of coronal restorations was 7.6 mm (SD±1.1). The correlation between the length of the post from the root canal orifice and the height of the coronal restoration was observed (p=0.025). A V-shaped pattern osseous defect (dehiscence) was typical and was found in 96 % of cases. Periodontal pocket was detected in 46 out of 53 cases with mean depth 4.63mm (SD±1.1). This study confirm the findings of other studies where was stated that vertical root fractures are caused by poorly designed dowels (too short, too wide or both), inappropriate selection of the tooth as a bridge abutment or as a consequence of overzealous endodontic forces by a restoration that exerted lateral pressure on the axial walls of the preparation.