What Are the Principles for Deciding Which Endodontically Treated Teeth with Vertical Root Fracture Could or Should Be Rescued?

Abstract

Root fracture remains a serious clinical problem, even as advances in comprehensive plaque control mean that caries and periodontitis, which used to be common bacterial infectious diseases, are mostly preventable.

Research by American endodontists showed that patients aged over 40 are vulnerable to vertical root fractures in upper premolars and upper and lower molars, especially in pulpless teeth, regardless of their experience of root canal treatment. In most cases, the teeth had to be extracted. A similar tendency was found in the data of Japanese patients; interestingly, the cracks in the teeth of Japanese patients initiated from cervical and apical areas with almost the same frequencies.

There is a consensus among clinicians that teeth with vertical root fractures need surgical treatments, such as extraction or root resection. However, modern dental microscopes and CBCT can often detect cracks at the initial stage. Based on our clinical experience, it is possible to preserve such vertically fractured teeth with initial cracks after they have been strengthened by modern adhesive materials. However, there is a risk of re-fracture and further extensive loss of periodontal tissue in the preserved teeth. In this article, I discuss the principles for deciding which endodontically treated teeth with vertical root fracture could or should be rescued.

Long-term etiological studies demonstrate that the best option for preventing root fracture is to preserve dental pulp. I outline a way to protect pulp better by indirect pulp capping with stepwise excavation.