Case Report
Volume 1 Issue 4 - 2015
Management of an Incomplete Vertical Root Fracture: An Alternative Clinical Approach and Treatment Finalisation Concept for A Case
M Omer Gorduysus1,2* and Burcu A Pektas1
1Department of General and Specialist Dental Practice, University of Sharjah, United Arab Emirates
2Department of Endodontics, Hacettepe University, Turkey
*Corresponding Author: M Omer Gorduysus, Department of General and Specialist Dental Practice, University of Sharjah, College of Dentistry, United Arab Emirates, Department of Endodontics, Faculty of Dentistry, Hacettepe University, Ankara, Turkey.
Received: April 14, 2015; Published: June 02, 2015
Citation: M Omer Gorduysus and Burcu A Pektas. “Management of an Incomplete Vertical Root Fracture: An Alternative Clinical Approach and Treatment Finalisation Concept for a Case” EC Dental Science 1.4 (2015): 180-185.
Abstract
In this case, the management of an incomplete vertical root fracture of a right lower second molar of sixty years old female patient, the finalization of the treatment and follow-up were presented as an alternative clinical approach versus extracting the tooth.
Keywords: Incomplete vertical root fracture; Root fracture; Treatment finalization; Vertical root fracture
Introduction
Patients regularly complain of painful teeth, and it is prudent to determine the cause and providing the indicated treatment. Cracked tooth syndrome (CTS) refers to an incomplete fracture of a vital tooth which describes the clinical character that involves the dentin and may extend to pulp [1]. Patients often report a history of teeth that occasionally give a sharp pain when biting certain foods. Sometimes they can specifically identify the offensive tooth, but often they cannot tell where the pain is coming from [2]. Because of the wide variety of different types of cracks in teeth, there may be a myriad of symptoms and presentations, making the diagnosis of a crack often difficult. The extensiveness of a crack may directly alter the prognosis assessment. Therefore, any possible crack should be examined prior to dental treatment [3].
Cracks in teeth can be divided into three basic categories [3]:
  1. Craze lines
  2. Fractures (also referred to as cracks)
  3. Split roots
Fractures extend deeper into the dentin than superficial craze lines. Dyes and transillumination are very helpful in visualizing potential root fractures [3]. Symptoms from a fractured tooth range from none to severe pain. A fractured tooth may be treated by a simple restoration, endodontics, or even extraction, depending upon the extent and orientation of the fracture, the degree of symptoms, and whether or not the symptoms can be eliminated [3]. Fractures may be present prior to endodontic treatment, secondary to endodontic treatment, or they may develop after endodontic treatment has been completed. Typically, these cracks lead to a split root, leaving the tooth with a poor prognosis. Therefore, diagnosing the existence and extent of a vertical root fracture is imperative prior to any restorative or endodontic treatment since these cracks can dramatically affect the overall success of treatment [3].
Vertical root fractures may arise from a physical traumatic injury, occlusal prematurities [4], repetitive parafunctional habits of heavy stressful chewing [5], or resorption-induced pathologic root fractures [6]. However, the most common cause of vertical root fractures may be iatrogenic dental treatment [4,6,7]. Dental Procedures such as the placement of posts and pins [8,9] or the tapping into place of a tightly fitting post or intra coranal restoration may induce a vertical root fracture. The most common dental procedure contributing to vertical root fracture is endodontic treatment [6].
Mandibular second molars have a higher incidence of vertical root fractures, followed by maxillary first molars and maxillary premolars [5]. Dental operating microscope, with magnification capabilities of over 25x, and with superb illumination, the clinician is now capable of observing intracoronal and extra coronal details with great precision [3].
Methodology
A 60 year-old female patient presented with “intermittent, sharp pain”. An intraoral exam revealed that a large failing amalgam with leaking margins on the right lower second molar. The tooth had a very painful response to percussion. No soft tissue changes recorded. The radiograph of the tooth (Figure 1) exhibited a widened periodontal ligament space but no periradicular radioluceny. The medical and dental histories of the patient were unremarkable. The bite test was increasing the discomfort. Amalgam filling was removed and seen a fracture line prolonged from distal to mesial also alongside of the distal axial wall and also towards to the floor of the pulp chamber partially (Figure 2a-b, Figure 3) conventional root canal therapy was completed with rotary system (ProTaper, Dentsply-Maillefer, Switzerland) and RC Prep (Premier, Norristown, PA, USA) as a lubricant. Copious irrigation with 2% sodium hypochlorite solution was employed throughout the procedure. Obturation of the root canals was performed using Protaper’s gutta-percha (For mesial canals F2 and for distal canal F3) and AH 26 (Dentsply Maillefer) root canal sealer was used (Figure 4) Later the tooth was submitted under the operation microscope to pursuit the incomplete vertical fracture line with Mueller burs and ultrasonic tips until the line disappears as much as possible (Figure 5a-b). After that the tooth was restored with glass ionomer following the bonding of two sides of the remaining craze line at the floor of the pulp chamber with an adhesive which was left over in obligation to the tooth structure and the critical extension of the vertical crack line (Figure 6) and crowned to finalize the case without any post for not to increase the stress over the tooth (Figure 7).
Figure 1: Initial (preoperative) radiograph.

Figure 2a-b: Intraoral views of vertical root fracture on the mandibular right second molar with rubber dam.

Figure 3: Intraoral views of vertical root fracture with operation microscope.

Figure 4: Final radiograph after endodontic treatment.

Figure 5a-b: Intraoral views using operation microscope after endodontic treatment.

Figure 6: Intraoral view after endodontic therapy, restoration with glass ionomer cement.

Figure 7: The finalized restoration with a crown.

Figure 8: One year follow up.
The outcome of the case was successful after one year follow up (Figure 8) and patient was using the tooth without any discomfort and pain, in spite of some small craze line left over. This small craze line which was left over was away from the canals. Removal or pursue of this small craze was not possible technically because of its strategically location which was the structure around it was consolidating the tooth structure and intentionally was decided to be left and decided to followed up.
Results
In this case the vertical incomplete root fracture of a 60 years old female on her right lower second molar managed successfully and the treatment finalized. After one year follow up patient had no any complaint or any x-ray finding.
Discussion
Vertical root fractures (VRF) sometimes represented by incomplete vertical lines extend through the long axis of the tooth. According to Gher., et al. the incidence of VRF is 2.3% [10]. In the literature generally trauma or iatrogenic factors are mentioned as the main reasons of the VRFs. In our case an old large amalgam filling and possible lateral or vertical forces related the chewing and mastication were the reason of the incomplete VRF which we had diagnosed. In most of the cases extraction seem the only alternative or rarely bonding and observing [11]. In our case we pursued the crack line to eliminate as deeper as possible and the remaining part bonded with a resin. After that the tooth was crowned to prevent the tooth from the forces and consolidate the tooth structure.
Conclusion
Using the magnification methods (Figure 9a-b-c) and related devices in clinical endodontics increase the success. In that context, the tooth which was mentioned in this case redeemed with an alternative clinical approach to a possible extraction. In this study, as an alternative to extraction, reinstating the comfort and function endodontically in a mandibular second right molar of a 60 years old female patient due to an incomplete vertical root fracture where localized distally.
Figure 9: One year follow up.
Bibliography
  1. Lynch CD and Mc Connell RJ. “The cracked tooth syndrome”. Journal (Canadian Dental Association) 68.8 (2002): 470-475.
  2. Jack DG Jr, DMD, FAGD, Compendium/February 2006/vol.27, No.2.
  3. Louis HB and Gary RH. “Pathways of the pulp”. Chapter1.
  4. Cameron CE. “Cracked tooth syndrome”. Journal of the American Dental Association 68.3 (1964): 405-411.
  5. Yeh CJ. “Fatigue root fracture: a spontaneous root fracture in nonendodontically treated teeth”. British Dental Journal 182.7 (1997): 261.
  6. Bender IB and Freedland JB. “Adult root fracture”. Journal of the American Dental Association 107.3 (1983): 413-419.
  7. Pitts DL and Natkin E. “Diagnosis and treatment of vertical root fractures”. Journal of Endodontics 9 (1983): 338.
  8. Fuss Z., et al. “An evaluation of endodontically treated vertical root fractured teeth: impact of operative procedures”. Journal of Endodontics 27.1 (2001): 46.
  9. Meister F., et al. “Diagnosis and possible causes of vertical root fractures”. Oral Surgery, Oral Medicine, and Oral Pathology 49.3 (1980): 243-253.
  10. Gher ME., et al. “Clinical survey of fractured teeth”. Journal of the American Dental Association 114.2 (1987): 174-177.
  11. Hedge MN., et al. “Vertical root fractures: Review and case report”. Journal of Interdisciplinary Dentistry 1.2 (2011): 101-104.
Copyright: © 2015 M Omer Gorduysus., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

PubMed Indexed Article


EC Pharmacology and Toxicology
LC-UV-MS and MS/MS Characterize Glutathione Reactivity with Different Isomers (2,2' and 2,4' vs. 4,4') of Methylene Diphenyl-Diisocyanate.

PMID: 31143884 [PubMed]

PMCID: PMC6536005


EC Pharmacology and Toxicology
Alzheimer's Pathogenesis, Metal-Mediated Redox Stress, and Potential Nanotheranostics.

PMID: 31565701 [PubMed]

PMCID: PMC6764777


EC Neurology
Differences in Rate of Cognitive Decline and Caregiver Burden between Alzheimer's Disease and Vascular Dementia: a Retrospective Study.

PMID: 27747317 [PubMed]

PMCID: PMC5065347


EC Pharmacology and Toxicology
Will Blockchain Technology Transform Healthcare and Biomedical Sciences?

PMID: 31460519 [PubMed]

PMCID: PMC6711478


EC Pharmacology and Toxicology
Is it a Prime Time for AI-powered Virtual Drug Screening?

PMID: 30215059 [PubMed]

PMCID: PMC6133253


EC Psychology and Psychiatry
Analysis of Evidence for the Combination of Pro-dopamine Regulator (KB220PAM) and Naltrexone to Prevent Opioid Use Disorder Relapse.

PMID: 30417173 [PubMed]

PMCID: PMC6226033


EC Anaesthesia
Arrest Under Anesthesia - What was the Culprit? A Case Report.

PMID: 30264037 [PubMed]

PMCID: PMC6155992


EC Orthopaedics
Distraction Implantation. A New Technique in Total Joint Arthroplasty and Direct Skeletal Attachment.

PMID: 30198026 [PubMed]

PMCID: PMC6124505


EC Pulmonology and Respiratory Medicine
Prevalence and factors associated with self-reported chronic obstructive pulmonary disease among adults aged 40-79: the National Health and Nutrition Examination Survey (NHANES) 2007-2012.

PMID: 30294723 [PubMed]

PMCID: PMC6169793


EC Dental Science
Important Dental Fiber-Reinforced Composite Molding Compound Breakthroughs

PMID: 29285526 [PubMed]

PMCID: PMC5743211


EC Microbiology
Prevalence of Intestinal Parasites Among HIV Infected and HIV Uninfected Patients Treated at the 1o De Maio Health Centre in Maputo, Mozambique

PMID: 29911204 [PubMed]

PMCID: PMC5999047


EC Microbiology
Macrophages and the Viral Dissemination Super Highway

PMID: 26949751 [PubMed]

PMCID: PMC4774560


EC Microbiology
The Microbiome, Antibiotics, and Health of the Pediatric Population.

PMID: 27390782 [PubMed]

PMCID: PMC4933318


EC Microbiology
Reactive Oxygen Species in HIV Infection

PMID: 28580453 [PubMed]

PMCID: PMC5450819


EC Microbiology
A Review of the CD4 T Cell Contribution to Lung Infection, Inflammation and Repair with a Focus on Wheeze and Asthma in the Pediatric Population

PMID: 26280024 [PubMed]

PMCID: PMC4533840


EC Neurology
Identifying Key Symptoms Differentiating Myalgic Encephalomyelitis and Chronic Fatigue Syndrome from Multiple Sclerosis

PMID: 28066845 [PubMed]

PMCID: PMC5214344


EC Pharmacology and Toxicology
Paradigm Shift is the Normal State of Pharmacology

PMID: 28936490 [PubMed]

PMCID: PMC5604476


EC Neurology
Examining those Meeting IOM Criteria Versus IOM Plus Fibromyalgia

PMID: 28713879 [PubMed]

PMCID: PMC5510658


EC Neurology
Unilateral Frontosphenoid Craniosynostosis: Case Report and a Review of the Literature

PMID: 28133641 [PubMed]

PMCID: PMC5267489


EC Ophthalmology
OCT-Angiography for Non-Invasive Monitoring of Neuronal and Vascular Structure in Mouse Retina: Implication for Characterization of Retinal Neurovascular Coupling

PMID: 29333536 [PubMed]

PMCID: PMC5766278


EC Neurology
Longer Duration of Downslope Treadmill Walking Induces Depression of H-Reflexes Measured during Standing and Walking.

PMID: 31032493 [PubMed]

PMCID: PMC6483108


EC Microbiology
Onchocerciasis in Mozambique: An Unknown Condition for Health Professionals.

PMID: 30957099 [PubMed]

PMCID: PMC6448571


EC Nutrition
Food Insecurity among Households with and without Podoconiosis in East and West Gojjam, Ethiopia.

PMID: 30101228 [PubMed]

PMCID: PMC6086333


EC Ophthalmology
REVIEW. +2 to +3 D. Reading Glasses to Prevent Myopia.

PMID: 31080964 [PubMed]

PMCID: PMC6508883


EC Gynaecology
Biomechanical Mapping of the Female Pelvic Floor: Uterine Prolapse Versus Normal Conditions.

PMID: 31093608 [PubMed]

PMCID: PMC6513001


EC Dental Science
Fiber-Reinforced Composites: A Breakthrough in Practical Clinical Applications with Advanced Wear Resistance for Dental Materials.

PMID: 31552397 [PubMed]

PMCID: PMC6758937


EC Microbiology
Neurocysticercosis in Child Bearing Women: An Overlooked Condition in Mozambique and a Potentially Missed Diagnosis in Women Presenting with Eclampsia.

PMID: 31681909 [PubMed]

PMCID: PMC6824723


EC Microbiology
Molecular Detection of Leptospira spp. in Rodents Trapped in the Mozambique Island City, Nampula Province, Mozambique.

PMID: 31681910 [PubMed]

PMCID: PMC6824726


EC Neurology
Endoplasmic Reticulum-Mitochondrial Cross-Talk in Neurodegenerative and Eye Diseases.

PMID: 31528859 [PubMed]

PMCID: PMC6746603


EC Psychology and Psychiatry
Can Chronic Consumption of Caffeine by Increasing D2/D3 Receptors Offer Benefit to Carriers of the DRD2 A1 Allele in Cocaine Abuse?

PMID: 31276119 [PubMed]

PMCID: PMC6604646


EC Anaesthesia
Real Time Locating Systems and sustainability of Perioperative Efficiency of Anesthesiologists.

PMID: 31406965 [PubMed]

PMCID: PMC6690616


EC Pharmacology and Toxicology
A Pilot STEM Curriculum Designed to Teach High School Students Concepts in Biochemical Engineering and Pharmacology.

PMID: 31517314 [PubMed]

PMCID: PMC6741290


EC Pharmacology and Toxicology
Toxic Mechanisms Underlying Motor Activity Changes Induced by a Mixture of Lead, Arsenic and Manganese.

PMID: 31633124 [PubMed]

PMCID: PMC6800226


EC Neurology
Research Volunteers' Attitudes Toward Chronic Fatigue Syndrome and Myalgic Encephalomyelitis.

PMID: 29662969 [PubMed]

PMCID: PMC5898812


EC Pharmacology and Toxicology
Hyperbaric Oxygen Therapy for Alzheimer's Disease.

PMID: 30215058 [PubMed]

PMCID: PMC6133268


News and Events


August Issue Release

We always feel pleasure to share our updates with you all. Here, notifying you that we have successfully released the August issue of respective journals and can be viewed in the current issue pages.

Submission Deadline for September Issue

Ecronicon delightfully welcomes all the authors around the globe for effective collaboration with an article submission for the September issue of respective journals. Submissions are accepted on/before August 21, 2020.

Certificate of Publication

Ecronicon honors with a "Publication Certificate" to the corresponding author by including the names of co-authors as a token of appreciation for publishing the work with our respective journals.

Best Article of the Issue

Editors of respective journals will always be very much interested in electing one Best Article after each issue release. The authors of the selected article will be honored with a "Best Article of the Issue" certificate.

Certifying for Review

Ecronicon certifies the Editors for their first review done towards the assigned article of the respective journals.

Latest Articles

The latest articles will be updated immediately on the articles in press page of the respective journals.

Immediate Assistance

The prime motto of this team is to clarify all the queries without any delay or hesitation to avoid the inconvenience. For immediate assistance on your queries please don't hesitate to drop an email to editor@ecronicon.uk