Incomplete Vertical Root Fractures Research Articles

Comparative evaluation of the accuracy of two electronic apex locators in detecting simulated incomplete vertical root fractures: An in vitro stereomicroscopic study

Aim: The aim of this study was to compare the accuracy of two different electronic apex locators (EALs) in detecting simulated incomplete vertical root fractures (VRFs). Materials and Methods: Thirty freshly extracted single-rooted teeth were randomly divided into three groups of 10 teeth each labeled as Groups A, B, and C. Incomplete VRFs were simulated in the coronal, middle, and apical one-third of the roots for Groups A, B, and C, respectively. The teeth were embedded in alginate mold and fracture location was determined with Root ZX and Propex EALs for each sample and each group. To calculate the actual length (AL), each sample was sectioned at the upper level of the vertical fracture, and the length was measured by setting the stopper of the #10 K file under a stereomicroscope at ×30 magnification. The electronic lengths and ALs were compared using computer software, and the results were analyzed using SPSS 28.0 at a 95% confidence level. Results: No significant differences were seen in the accuracy of the two EALs when compared with ALs. Root ZX showed significantly longer measurements than ALs in groups B and C. Conclusion: The tested EALs showed low accuracy (20%) in detecting simulated incomplete VRFs with a tendency for longer measurements compared to ALs.

Influence of a Metal Artifact Reduction Filter on the Diagnostic Accuracy of Complete and Incomplete Vertical Root Fractures

IntroductionThis study aimed to assess the influence of the e-vol DX BAR filter on the diagnostic accuracy of complete and incomplete vertical root fractures (VRFs). MethodsTwenty single-rooted teeth were selected. The tooth crowns were removed, and the root canals were prepared up to a 40/.06 instrument (ProTaper Next). Each specimen was scanned in a Prexion 3D cone-beam computed tomography (CBCT) device, in a dry human skull, in 4 different situations: no root canal filling, gutta-percha, fiberglass post, and metal post. The specimens were fractured in a universal testing machine by using a customized wedge. Each specimen was reinspected to confirm the presence of incomplete VRFs. Another set of CBCT scans was performed. Then, the fractures were completed in the universal testing machine, the teeth were reinspected, and the CBCT images were acquired again. Images were assessed by using the e-Vol DX software system, with the BAR filter and with the original images, for the diagnosis of VRFs. Statistical analysis was performed by using the DeLong and McNemar tests for the comparison of the area under the receiver operating characteristic curves (AUC), accuracy, sensitivity, and specificity values. ResultsThe use of the BAR filter did not improve the diagnostic values of AUC, accuracy, sensitivity, and specificity in both fracture patterns (P > .05). Incomplete VRFs presented significantly lower AUC, accuracy, and sensitivity compared with complete VRFs (P < .0001). ConclusionsThe BAR filter did not improve the diagnostic accuracy of VRFs. The intracanal materials also did not influence the diagnosis. Incomplete VRFs were highly associated with a decrease in sensitivity.

Development and validation of a method for creating incomplete vertical root fracture in extracted teeth.

The present study reported a method for inducing incomplete root fracture in human extracted teeth for the purpose of evaluating the merits of different diagnostic imaging techniques. Thirty-five single-rooted teeth were inspected under magnification and transillumination to exclude previously fractured teeth. Tooth crowns were removed, and the root canals were prepared up to the ProTaper Next X4 (40.06) file. Each root was lined with wax and embedded in a polystyrene resin block. The setup was attached to a universal testing machine for pressing a customized conical wedge (diameter at tip: 0.6mm; taper: 0.2mm/mm) into the instrumented canal with a 2kN load at 5mm/min. The machine was programmed to stop after a sudden 10% drop in loading force. Each specimen was removed from the resin block and inspected under × 20 magnification and transillumination to identify the fracture characteristics (pattern, surfaces and root-third affected). The gap width of each specimen was measured at different locations along the fracture line. The protocol induced incomplete vertical root fractures in all specimens. Fracture widths were < 100μm in all specimens (mean gap width: 34.9μm). The proposed methodology was successful in inducing incomplete vertical root fractures with characteristics that resemble the clinical presentation of these conditions. The method is easy to execute, highly reproducible and helps to minimize bias in laboratory studies that aims to mimic vertical root fractures.

Effect of cone-beam computed tomography metal artefact reduction on incomplete subtle vertical root fractures.

This study compared the accuracy of detection of incomplete vertical root fractures (VRFs) in filled and unfilled teeth on cone-beam computed tomography images with and without a metal artefact reduction (MAR) algorithm. Forty single-rooted maxillary premolars were selected and, after endodontic instrumentation, were categorized as unfilled teeth without fractures, filled teeth without fractures, unfilled teeth with fractures, or filled teeth with fractures. Each VRF was artificially created and confirmed by operative microscopy. The teeth were randomly arranged, and images were acquired with and without the MAR algorithm. The images were evaluated with OnDemand software (Cybermed Inc., Seoul, Korea). After training, 2 blinded observers each assessed the images for the presence and absence of VRFs 2 times separated by a 1-week interval. P-values<0.05 were considered to indicate significance. Of the 4 protocols, unfilled teeth analysed with the MAR algorithm had the highest accuracy of incomplete VRF diagnosis (0.65), while unfilled teeth reviewed without MAR were associated with the least accurate diagnosis (0.55). With MAR, an unfilled tooth with an incomplete VRF was 4 times more likely to be identified as having an incomplete VRF than an unfilled tooth without this condition, while without MAR, an unfilled tooth with an incomplete VRF was 2.28 times more likely to be identified as having an incomplete VRF than an unfilled tooth without this condition. The use of the MAR algorithm increased the diagnostic accuracy in the detection of incomplete VRF on images of unfilled teeth.

Vertical Root Fracture-Diagnosis, Surgical Perspectives and Management―A Review

Endodontically treated teeth are often associated with vertical root fracture (VRF) and it becomes difficult to differentiate a tooth with this condition from an endodontically failed one or one with concomitant periodontal involvement. The cause of VRF is mainly trauma and iatrogenic reasons. Both complete and incomplete VRF constitute an ongoing problem in dentistry because they are difficult to be diagnosed in the early stages. In majority of the cases, tooth extraction is the only reasonable treatment when the VRF is finally diagnosed. Treatment options included extraction of single rooted teeth, but with the advent of adhesive dentistry. There is a paradigm shift towards preservation of these teeth.

Influence of the artefact reduction algorithm of Picasso Trio CBCT system on the diagnosis of vertical root fractures in teeth with metal posts.

To assess the influence of the artefact reduction algorithm (AR) available on the Picasso Trio 3D(®) imaging system (Vatech, Hwaseong, Republic of Korea) on image quality [greyscale values, contrast-to-noise ratio (CNR) and artefact formation] and diagnosis of vertical root fractures (VRFs) in the teeth with intracanal metal posts. 30 uniradicular teeth had their crowns removed and their roots endodontically treated to receive intracanal metal posts. In 20 teeth, both complete (n = 10) and incomplete (n = 10) VRFs were created. Each tooth was scanned twice, with and without AR activation. The mean and variation of greyscale values, as well as CNR, were calculated for all images. Subsequently, an evaluator compared the amount of artefact (cupping, white streaks and dark bands) in all images. Five evaluators rated for VRF presence using a five-point scale. Mean greyscale values and CNR were significantly decreased in images acquired with the AR. The usage of the algorithm promoted an overall reduction of image artefacts. Regarding the diagnosis of complete and incomplete VRFs, the use of the AR had an overall negative impact on specificity and accuracy. While indeed reducing artefact formation, the use of the AR, instead of improving the impact on the diagnosis of VRFs in teeth with intracanal metal posts, had a negative impact on the diagnosis.

Incomplete vertical root fracture associated with lateral compaction technique: a microscopic analysis

Objective:This study evaluated the effects of root canal obturation employing lateral compaction technique and spreader load of 1.5 kg on the incidence of complete (CVRF) or incomplete vertical root fractures (IVRF). Material and Methods: Twenty-seven distal roots of extracted human mandibular molars were used. All root canals were prepared by biomechanical step-back technique and obturated by lateral compaction technique. The prepared roots were distributed into two groups: G1- experimental (n=17) and G2- control (n=10). During obturation, load of 1.5 kg was applied to a size 30 finger spreader. Pre- and post-obturation images of the coronal portion of the roots were captured by inverted digital microscopy and analyzed by one trained examiner. Data were evaluated by Fisher’s test (p &lt; 0.05) using GrapH Pad Prism 5.0. Results: No roots exhibited CVRF. All fractures observed before and after obturation were IVRF or “other defects”. In G2 (control group), there was no increase of IVRF number. Interestingly, G1 presented an increase in the IVRF number to 70,59% in the 12 teeth out of 17 teeth studied. The statistical analysis showed that the mean of IVRF increased significantly in G1 when compared to G2 (p &lt; 0.05). Conclusions: The application of a 1.5 kg spreader load during lateral compaction technique does not produce complete vertical root fractures, but may produce incomplete fractures or “other defects”.

Surgical Management of Vertical Root Fractures for Posterior Teeth: Report of Four Cases

IntroductionThe objective of this article was to present a surgical treatment option for teeth with incomplete vertical root fracture in maxillary and mandibular posterior teeth. MethodsFour cases are presented in which 1 endodontically treated maxillary or mandibular molar had an incomplete vertical root fracture involving 1 of the roots. The tooth underwent a flap elevation procedure to visualize the pattern of bone loss and assess the extent of root fracture. The fracture line was eliminated by resecting the root in a beveled manner, after which root-end preparation and root-end filling were performed by using mineral trioxide aggregate. The osteotomy was covered with an absorbable collagen membrane. Cases were followed up for 8–24 months after surgery. ResultsThe procedure was shown to be predictable and successful in this series. Root length was preserved, and tooth extraction was avoided. ConclusionsThe microsurgical treatment option for multirooted teeth with incomplete vertical root fracture resulted in long-term clinical success.

A new surgical technique for preservation of endodontically treated teeth with coronally located vertical root fractures: a prospective case series

The purpose of this study was to present a new surgical preservation technique for teeth with incomplete vertical root fracture. Seventeen patients with 1 endodontically treated maxillary anterior tooth in which an incomplete vertical root fracture involving only the buccal side was suspected underwent a flap elevation procedure to visualize the pattern of bone loss and assess the type of root fracture. If the preoperative diagnosis was confirmed, a groove following the fracture line was prepared using retro-tips driven by an ultrasonic device and sealed with mineral trioxide aggregate after filling of the bone defect with calcium sulfate. A total of 10 vertical root fracture repair procedures were performed. At 12 months' follow-up, all cases showed clinical and radiographic success. After 33 months, 7 patients were available for a follow-up: 5 cases remained successful, and 2 teeth (lateral incisors) failed. The present surgical approach for preservation of teeth with incomplete vertical root fracture demonstrated satisfactory results regarding clinical outcome.

Accuracy of three different electronic apex locators in detecting simulated horizontal and vertical root fractures

The aim of this in vitro study was to evaluate the accuracy of three electronic apex locators (EALs): Root ZX, Foramatron D10 and Apex NRG, in the detection of fractures in teeth having simulated horizontal and vertical root fractures. A total of 90 extracted intact, straight, single-rooted teeth were divided into six groups of 15 teeth each. In Groups A, B and C, an incomplete horizontal fracture was simulated by preparing a horizontal incision in the coronal, middle or apical portion of the root until the circumferential half of the canal was exposed in the horizontal plane respectively. In Groups D, E and F, an incomplete vertical root fracture was simulated by preparing a vertical straight incision to expose the canal in the coronal, middle or apical portion of the root all the way in the longitudinal plane respectively. The simulated fractures were 0.25 mm in thickness in all groups. The teeth were embedded in 1% agar and the canals were irrigated with saline solution during electronic measurement. Detection of the simulated root fractures was established with a size 10 K-file when the meter value reached 'APEX' on each EAL. In Groups A, B and C, Kruskal-Wallis tests revealed that there were no statistically significant differences between the three EALs. However, statistically significant differences were found among the EALs in Groups D, E and F (P < 0.0001, one-way anova and Tukey's post-hoc test). In conclusion, the three EALs tested were accurate and acceptable clinical tools in the detection of horizontal root fractures. However, the three EALs were unreliable in detecting the position of vertical root fractures.

PR 33 An in vitro microleakage comparison of the sealing ability of amalgam alloy and Geristore® when used as an incomplete vertical root fracture filling material

PR 33 An in vitro microleakage comparison of the sealing ability of amalgam alloy and Geristore® when used as an incomplete vertical root fracture filling material

Repair of incomplete vertical root fractures in endodontically treated teeth—In vivo trials

An in vivo clinical study was performed to evaluate the healing of a new approach to the repair of incomplete vertical root fractures. The two-stage surgical procedure incorporated ultrasonic fracture cleaning, bonding of the fracture repair with silver glass-ionomer cement, placement of a bone graft material, and application of guided-tissue regeneration. Of the six roots in the study, five failed within 2 to 11 months. One root continued to be symptom-free, without periodontal pocket formation for 1 yr, but then failed because of extension of the incomplete root fracture to the lingual of the root.