Vertical root fractures: clinical and radiographic diagnosis.
BACKGROUND
Early detection and management of vertical root fractures, or VRFs, remain a vexing issue that has caused needless suffering for patients as well as for dentists. The authors present techniques to aid the dentist in recognizing VRFs.


METHODS
During a five-year period, the authors examined 36 patients who had VRFs. Absent control subjects and a larger number of patients, the authors did not design this investigation for statistical analysis. They diagnosed VRFs through dental histories and clinical and radiographic examinations.


RESULTS
The study revealed VRFs in 36 teeth, two of which were vital and 34 of which were nonvital (that is, endodontically treated). The 34 VRFs resulted from excessive operative procedures performed in the root canal after endodontic therapy. Thirty-one of these 34 VRFs were caused by poorly designed dowels (too long, too wide or both) or inappropriate selection of the tooth as a bridge abutment; two VRFs were caused by a restoration that exerted lateral pressure on the axial walls of the preparation; and one VRF was caused by overzealous endodontic forces. The VRFs in the two vital teeth were in men who had a history of bruxism or clenching.


CONCLUSIONS
VRFs can be detected early by listening to the patient's chief complaints, carefully examining periapical and bitewing radiographs and performing a thorough clinical examination.
University of the Pacific School of Dentistry, San Francisco, Calif. 94115, USA. scohen@newmentor.com
Stephen
S
Cohen
Lucia
L
Blanco
Louis
L
Berman
D000328:Adult; D000368:Aged; D001641:Bicuspid / Q000293:injuries; D000044:Dental Abutments / Q000009:adverse effects; D017267:Dental Prosthesis Design / Q000009:adverse effects; D003793:Dental Restoration, Permanent / Q000009:adverse effects; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008963:Molar / Q000293:injuries; D011176:Post and Core Technique / Q000009:adverse effects / Q000295:instrumentation; D011859:Radiography; D012390:Root Canal Therapy / Q000009:adverse effects; D014082:Tooth Fractures / Q000175:diagnosis* / Q000000981:diagnostic imaging; D014092:Tooth Root / Q000293:injuries*; D019553:Tooth, Nonvital / Q000150:complications