title: Diagnosis of Vertical Root Fractures in Restored Endodontically Treated Teeth: A Time-dependent Retrospective Cohort Study.
abstract: BACKGROUND
  The purpose of this study was to examine different patient- and treatment-related factors associated with the time of presentation of vertical root fractures (VRFs) in endodontically treated teeth restored with crowns.
  
  
  METHODS
  One hundred ninety-seven root-filled, crowned teeth with no post and suspected of VRFs were included in the study. Patient details with relevance to endodontic treatment and clinical signs/symptoms were documented, and radiographs were taken. A diagnosis of a VRF was confirmed after surgical flap elevation. Frequency distributions were determined, and statistical analyses were performed using Pearson chi-square analysis, Fisher exact test, cross tabulation, Pearson correlation, and multiple logistic regression.
  
  
  RESULTS
  Mandibular molars (34%) and maxillary premolars (22.8%) were the most frequently affected teeth. The postoperative time to the diagnosis of a VRF was 4.35 (±1.96) years. Female patients, posterior teeth, overfilled canals, and patients older than 40 years were associated with the presentation of VRFs within 5 years of the postoperative period. Clinical findings most frequently observed were pain on percussion (60%), pain on palpation (62%), presence of a deep narrow pocket (81%), and sinus tract/swelling (67%). "Halo"-type radiolucency (48.7%) was the most common radiographic feature related to VRFs.
  
  
  CONCLUSIONS
  Pain on palpation/percussion, deep narrow pocket, sinus tract, and halo-type radiolucency are characteristic features of VRFs. Posterior teeth, overfilled canals, female patients, and older patients (>40 years) presenting with the previously described clinical features in endodontically treated teeth restored with crowns are more likely to present with VRFs within 5 years postoperatively.
authors.affiliation: Department of Conservative Dentistry and Endodontics, Thai Moogambigai Dental College and Hospital, Dr. MGR Educational and Research Institute University, Chennai, India. Electronic address: arpradeep@vsnl.com.
authors.forename: Angambakkam Rajasekaran
authors.initials: AR
authors.lastname: PradeepKumar
authors.affiliation: Department of Endodontology, Academic Centre for Dentistry Amsterdam, Amsterdam, The Netherlands.
authors.forename: Hagay
authors.initials: H
authors.lastname: Shemesh
authors.affiliation: Department of Conservative Dentistry and Endodontics, Tamil Nadu Government Dental College and Hospital, Chennai, India.
authors.forename: Sundaramurthy
authors.initials: S
authors.lastname: Jothilatha
authors.affiliation: Department of Dental and Maxillofacial Surgery, SMF-Dr. Rangarajan Memorial Hospital, Chennai, India.
authors.forename: Rangarajan
authors.initials: R
authors.lastname: Vijayabharathi
authors.affiliation: Department of Conservative Dentistry and Endodontics, Saveetha Dental College and Hospital, Chennai, India.
authors.forename: Somasundaram
authors.initials: S
authors.lastname: Jayalakshmi
authors.affiliation: Discipline of Endodontics, Faculty of Dentistry, Toronto, Ontario, Canada.
authors.forename: Anil
authors.initials: A
authors.lastname: Kishen
mesh_terms: D003442:Crowns; D003952:Diagnostic Imaging; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D012390:Root Canal Therapy; D013524:Surgical Flaps; D013997:Time Factors; D014082:Tooth Fractures / Q000175:diagnosis*; D014092:Tooth Root / Q000293:injuries*; D019553:Tooth, Nonvital
keywords: Crown; overfilled canals; post; root canal treatment; vertical root fracture