Root fracture in lower molar.

Patient indicated for endodontic treatment of tooth 45 with restorative purpose, reported pain when chewing and touching tooth 46. In the clinical examination it was observed prosthetic crown in that tooth besides gingival recession and pain to percussion and palpation. Radiographic examination revealed images compatible with root fracture: fracture line in the furcation, ¨J¨ image in the distal root and enlarged image of the distal canal.

The diagnosis was, therefore, a root fracture and the patient was referred for exodontia of the dental element.    

Root fracture in lower molar. In: Furtado et al. Brazilian Journal of Health Research 2010; 12(2) : 61-68 |.

ABSTRACT One of the problems that deserves attention in endodontics is the late diagnosis of vertical root fractures. Objective: To alert the general dentist about the importance of early diagnosis of vertical root fractures (VFR) to prevent future tooth loss. Materials and Methods: Through a search in textbooks, Medline database and other scientific websites, a literature review on the diagnosis of VFR was performed. Results: It was found that endodontically treated teeth, those with inadequate intraradicular retainers and fixed prosthesis abutments are the most affected teeth. Upper premolars and patients with an average age of 50 years are the most prevalent. The most common causes are due to iatrogenic factors. In the clinical examination, periodontal pocket probing, fistulography, transillumination, and mobility and pulp vitality tests stand out. On radiographic examination, a thickening of the periodontal ligament, periapical radiolucency and separation of the root fragments can be observed. Computed tomography is a great aid to diagnosis, but in case of doubt, one should always resort to exploratory surgery. Conclusion: We conclude that for the early diagnosis of VFR, it is necessary to thoroughly evaluate each of the stages of subjective and objective semiology.

INTRODUCTION: Vertical root fractures (VFR) are a challenge for the dental surgeon in terms of early detection and management. Diagnosing these fractures is essential prior to any endodontic or restorative treatment as they can dramatically affect treatment success.
They are characterized by a complete or incomplete fracture line that follows longitudinally along the long axis of the tooth in an apical direction.

It often extends through the pulp and the periodontium.

Fractures represent 10.9% of the causes of tooth extractions, with higher incidence in endodontically treated teeth.
The diagnosis of VFR usually becomes difficult because there are no exact signs, symptoms and radiographic characteristics, and it can be confused with an endodontic treatment failure and even periodontal disease. The most common signs and symptoms of VFR in endodontically treated teeth are pain, edema, the presence of a fistula, and an isolated, deep, narrow periodontal pocket. The radiographic characteristics are represented by thickening of the periodontal ligament; vertical, localized and deep bone loss; localized periradicular bone loss (bone loss halo).

Root fracture in lower molar.

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