Case Report/Clinical Techniques| Volume 37, ISSUE 1, P97-102, January 2011

Diagnosis and Treatment of Endodontically Treated Teeth with Vertical Root Fracture: Three Case Reports with Two-year Follow-up

Published:November 15, 2010DOI:



      Vertical root fracture (VRF) is an important threat to the tooth’s prognosis during and after root canal treatment. Often the detection of these fractures occurs years later by using conventional periapical radiographs. However, recent studies have addressed the benefits of computed tomography to diagnose these problems earlier. Accurately diagnosed VRFs have been treated by extraction of teeth, with minimal damage to the periodontal ligament, extraoral bonding of fractured segments with an adhesive resin cement, and intentional replantation of teeth after reconstruction.


      The 3 case reports presented here describe the diagnosis and treatment of vertically fractured teeth that had been previously treated endodontically. Cone-beam computed tomography (CBCT) was used for diagnostic imaging to detect VRFs. Vertically fractured roots were carefully extracted and extraorally treated by using a self-etching dual-cure adhesive resin cement, and intentional replantations were performed after reconstruction.


      After a mean follow-up period of 2 years, the teeth were asymptomatic. There was no clinical ankylosis, and diagnosis by using CBCT scans showed reduced periapical radiolucency.


      Extraoral bonding of fractured segments and intentional replantation of teeth after reconstruction provide an alternative treatment to extraction, especially for anterior teeth. Computed tomography–assisted VRF diagnosis is helpful in detecting fractures; however, higher-resolution tomography units providing better image quality would be a better choice for improved visualization of these fractures.

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        • Tamse A.
        • Fuss Z.
        • Lustig J.
        • Kaplavi J.
        An evaluation of endodontically treated vertically fractured teeth.
        J Endod. 1999; 25: 506-508
        • Sedgley C.M.
        • Messer H.H.
        Are endodontically treated teethmore brittle?.
        J Endod. 1992; 18: 332-335
        • Coppens C.R.M.
        • DeMoor R.J.G.
        Prevalence of vertical root fractures in extracted endodontically treated teeth.
        Int Endod J. 2003; 36: 926
        • Kawai K.
        • Masaka N.
        Vertical root fracture treated by bonding fragments and rotational replantation.
        Dent Traumatol. 2002; 18: 42-45
        • Hayashi M.
        • Kinomoto Y.
        • Miura M.
        • Sato I.
        • Takeshige F.
        • Ebisu S.
        Short-term evaluation of intentional replantation of vertically fractured roots reconstructed with dentin-bonded resin.
        J Endod. 2002; 28: 120-124
        • Arıkan F.
        • Franko M.
        • Gürkan A.
        Replantation of a vertically fractured maxillary central incisor after repair with adhesive resin.
        Int Endod J. 2008; 41: 73-79
        • Kudou Y.
        • Kubota M.
        Replantation with intentional rotation of a complete vertically fractured root using adhesive resin cement.
        Dent Traumatol. 2003; 19: 115-117
        • Hayashi M.
        • Kinomoto Y.
        • Takeshige F.
        • Ebisu S.
        Prognosis of intentional replantation of vertically fractured roots reconstructed with dentin-bonded resin.
        J Endod. 2004; 30: 145-148
        • Öztürk M.
        • Çelik Ünal G.
        A successful treatment of vertical root fracture: a case report and 4-year follow-up.
        Dent Traumatol. 2008; 24: e56-e60
        • Hassan B.
        • Metska M.E.
        • Ozok A.R.
        • van der Stelt P.
        • Wesselink R.
        Detection of vertical root fractures in endodontically treated teeth by a cone beam computed tomography scan.
        J Endod. 2009; 35: 719-722
        • Nesari R.
        • Rossman L.E.
        • Kratchman S.I.
        Cone-beam computed tomography in endodontics: are we there yet?.
        Compend Contin Educ Dent. 2009; 30: 312-322
        • Fuss Z.
        • Lustig J.
        • Katz A.
        • Tamse A.
        An evaluation of endodontically treated vertical root fractured teeth: impact of operative procedures.
        J Endod. 2001; 27: 46-48
        • Bernardes R.A.
        • de Moraes I.G.
        • Duarte M.A.H.
        • Azevedo B.C.
        • de Azevedo J.R.
        • Bramante C.M.
        Use of cone-beam volumetric tomography in the diagnosis of root fractures.
        Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009; 108: 270-277
        • Hassan B.
        • Metska M.E.
        • Ozok A.R.
        • van der Stelt P.
        • Wesselink P.R.
        Comparison of five-cone beam computed tomography systems for the detection of vertical root fractures.
        J Endod. 2010; 36: 126-129
        • Wenzel A.
        • Neto F.H.
        • Frydenberg M.
        • Kirkevang L.L.
        Variable-resolution cone-beam computerized tomography with enhancement filtration compared with intraoral photostimulable phosphor radiography in detection of transverse root fractures in an in vitro model.
        Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009; 108: 939-945
        • Kamburoğlu K.
        • Murat S.
        • Yüksel S.P.
        • Cebeci A.R.
        • Horasan S.
        Detection of vertical root fracture using cone-beam computerized tomography: an in vitro assessment.
        Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2010; 109: e74-e81
        • Madison III, J.G.
        • Hokett S.D.
        The effects of different tetracyclines on the dentin root surface of instrumented, periodontally involved human teeth: a comparative scanning electron microscope study.
        J Periodontol. 1997; 68: 739-745
        • Shemesh H.
        • van Soest G.
        • Wu M.-K.
        • Wesselink P.R.
        Diagnosis of vertical root fractures with optical coherence tomography.
        J Endod. 2008; 34: 739-742
        • Huang D.
        • Swanson E.A.
        • Lin C.P.
        • et al.
        Optical coherence tomography.
        Science. 1991; 254: 1178-1181
        • Bouillaguet S.
        • Troesch S.
        • Wataha J.C.
        • Krejci I.
        • Meyer J.M.
        • Pashley D.H.
        Microtensile bond strength between adhesive cements and root canal dentin.
        Dent Mater. 2003; 19: 199-205
        • Hayashi M.
        • Okamura K.
        • Wu H.
        • et al.
        The root canal bonding of chemical-cured total-etch resin cements.
        J Endod. 2008; 34: 583-586
        • Andreasen J.O.
        • Munksgaard E.C.
        • Fredebo L.
        • Rud J.
        Periodontal tissue regeneration including cementogenesis adjacent to dentin-bonded retrograde composite fillings in humans.
        J Endod. 1993; 19: 151-153
        • Zaman K.U.
        • Sugaya T.
        • Hongo O.
        • Kato H.
        A study of attached and oriented human periodontal ligament cells to periodontally diseased cementum and dentin after demineralizing with neutral and low pH etching solution.
        J Periodontol. 2000; 71: 1094-1099
        • Hammerström L.
        • Blomlöf L.
        • Lindskog S.
        Dynamics of dentoalveolar ankylosis and associated root resorption.
        Endod Dent Traumatol. 1989; 5: 163-175
        • Andersson L.
        • Blomlöf L.
        • Lindskog S.
        • Feiglin B.
        • Hammerström L.
        Tooth anyklosis: clinical, radiographic and histological assessments.
        Int J Oral Surg. 1984; 13: 423-431
        • Stenvik A.
        • Beyer-Olsen E.M.
        • Abyholm F.
        • Haanaes H.R.
        • Gerner N.W.
        Validity of the radiographic assessment of ankylosis: evaluation of long-term reactions in 10 monkey incisors.
        Acta Odontol Scand. 1990; 48: 265-269
        • Scarfe W.C.
        • Levin M.D.
        • Gane D.
        • Farman A.G.
        Use of cone beam computed tomography in endodontics.
        Int J Dent. 2009; 2009 ([published online ahead of print March 31, 2010]) (:634567, doi:10.1155/2009/634567)
        • Scarfe W.C.
        • Farman A.G.
        What is cone-beam CT and how does it work?.
        Dent ClinNorth Am. 2008; 52: 707-730