Cargando…

Present status and future directions: vertical root fractures in root filled teeth

Vertical root fracture (VRF) is a common reason for the extraction of root filled teeth. The accurate diagnosis of VRF may be challenging due to the absence of clinical signs, whilst conventional radiographic assessment is often inconclusive. However, an understanding of the aetiology of VRFs, and m...

Descripción completa

Detalles Bibliográficos
Autores principales: Patel, Shanon, Bhuva, Bhavin, Bose, Rahul
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9324143/
https://www.ncbi.nlm.nih.gov/pubmed/35338655
http://dx.doi.org/10.1111/iej.13737
_version_ 1784756734931238912
author Patel, Shanon
Bhuva, Bhavin
Bose, Rahul
author_facet Patel, Shanon
Bhuva, Bhavin
Bose, Rahul
author_sort Patel, Shanon
collection PubMed
description Vertical root fracture (VRF) is a common reason for the extraction of root filled teeth. The accurate diagnosis of VRF may be challenging due to the absence of clinical signs, whilst conventional radiographic assessment is often inconclusive. However, an understanding of the aetiology of VRFs, and more importantly, the key predisposing factors, is crucial in identifying teeth that may be susceptible. Thorough clinical examination with magnification and co‐axial lighting is essential in identifying VRFs, and although CBCT is unable to reliably detect VRFs per se, the pattern of bone loss typically associated with VRF can be fully appreciated, and therefore, increases the probability of correct diagnosis and management. The prevalence of VRFs in root filled teeth is significantly greater than in teeth with vital pulps, demonstrating that the combination of loss of structural integrity, presence of pre‐existing fractures and biochemical effects of loss of vitality is highly relevant. Careful assessment of the occlusal scheme, presence of deflective contacts and identification of parafunctional habits are imperative in both preventing and managing VRFs. Furthermore, anatomical factors such as root canal morphology may predispose certain teeth to VRF. The influence of access cavity design and root canal instrumentation protocols should be considered although the impact of these on the fracture resistance of root filled teeth is not clearly validated. The post‐endodontic restoration of root filled teeth should be expedient and considerate to the residual tooth structure. Posts should be placed ‘passively’ and excessive ‘post‐space’ preparation should be avoided. This narrative review aims to present the aetiology, potential predisposing factors, histopathology, diagnosis and management of VRF and present perspectives for future research. Currently, there are limited options other than extraction for the management of VRF, although root resection may be considered in multi‐rooted teeth. Innovative techniques to ‘repair’ VRFs using both orthograde and surgical approaches require further research and validation. The prevention of VRFs is critical; identifying susceptible teeth, utilizing conservative endodontic procedures, together with expedient and appropriate post‐endodontic restorative procedures is paramount to reducing the incidence of terminal VRFs.
format Online
Article
Text
id pubmed-9324143
institution National Center for Biotechnology Information
language English
publishDate 2022
publisher John Wiley and Sons Inc.
record_format MEDLINE/PubMed
spelling pubmed-93241432022-07-30 Present status and future directions: vertical root fractures in root filled teeth Patel, Shanon Bhuva, Bhavin Bose, Rahul Int Endod J Review Articles Vertical root fracture (VRF) is a common reason for the extraction of root filled teeth. The accurate diagnosis of VRF may be challenging due to the absence of clinical signs, whilst conventional radiographic assessment is often inconclusive. However, an understanding of the aetiology of VRFs, and more importantly, the key predisposing factors, is crucial in identifying teeth that may be susceptible. Thorough clinical examination with magnification and co‐axial lighting is essential in identifying VRFs, and although CBCT is unable to reliably detect VRFs per se, the pattern of bone loss typically associated with VRF can be fully appreciated, and therefore, increases the probability of correct diagnosis and management. The prevalence of VRFs in root filled teeth is significantly greater than in teeth with vital pulps, demonstrating that the combination of loss of structural integrity, presence of pre‐existing fractures and biochemical effects of loss of vitality is highly relevant. Careful assessment of the occlusal scheme, presence of deflective contacts and identification of parafunctional habits are imperative in both preventing and managing VRFs. Furthermore, anatomical factors such as root canal morphology may predispose certain teeth to VRF. The influence of access cavity design and root canal instrumentation protocols should be considered although the impact of these on the fracture resistance of root filled teeth is not clearly validated. The post‐endodontic restoration of root filled teeth should be expedient and considerate to the residual tooth structure. Posts should be placed ‘passively’ and excessive ‘post‐space’ preparation should be avoided. This narrative review aims to present the aetiology, potential predisposing factors, histopathology, diagnosis and management of VRF and present perspectives for future research. Currently, there are limited options other than extraction for the management of VRF, although root resection may be considered in multi‐rooted teeth. Innovative techniques to ‘repair’ VRFs using both orthograde and surgical approaches require further research and validation. The prevention of VRFs is critical; identifying susceptible teeth, utilizing conservative endodontic procedures, together with expedient and appropriate post‐endodontic restorative procedures is paramount to reducing the incidence of terminal VRFs. John Wiley and Sons Inc. 2022-04-15 2022-05 /pmc/articles/PMC9324143/ /pubmed/35338655 http://dx.doi.org/10.1111/iej.13737 Text en © 2022 The Authors. International Endodontic Journal published by John Wiley & Sons Ltd on behalf of British Endodontic Society. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ (https://creativecommons.org/licenses/by-nc-nd/4.0/) License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.
spellingShingle Review Articles
Patel, Shanon
Bhuva, Bhavin
Bose, Rahul
Present status and future directions: vertical root fractures in root filled teeth
title Present status and future directions: vertical root fractures in root filled teeth
title_full Present status and future directions: vertical root fractures in root filled teeth
title_fullStr Present status and future directions: vertical root fractures in root filled teeth
title_full_unstemmed Present status and future directions: vertical root fractures in root filled teeth
title_short Present status and future directions: vertical root fractures in root filled teeth
title_sort present status and future directions: vertical root fractures in root filled teeth
topic Review Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9324143/
https://www.ncbi.nlm.nih.gov/pubmed/35338655
http://dx.doi.org/10.1111/iej.13737
work_keys_str_mv AT patelshanon presentstatusandfuturedirectionsverticalrootfracturesinrootfilledteeth
AT bhuvabhavin presentstatusandfuturedirectionsverticalrootfracturesinrootfilledteeth
AT boserahul presentstatusandfuturedirectionsverticalrootfracturesinrootfilledteeth