ABSTRACTObjectiveVertical root fracture (VRF) in endodontically treated molars (ETMs) is a multifactorial condition. However, the relationship between residual pericervical and apical dentine in ETMs and VRF has yet to be fully assessed. This study aimed to investigate the association between residual pericervical and apical dentine and VRF in ETMs.Material and MethodsETMs with VRFs (44 cases) and those without VRFs (92 controls) were included. Residual dentine at pericervical level and apical terminus of root canal filling (RCF) were assessed based on the ratio between the mesiodistal widths of the RCF and root on periapical radiographs. The ratio was converted into four categories: “intact canal”, “minimum preparation”, “traditional preparation”, and “excessive preparation” based on calculated cut‐off values. History of root canal re‐treatment (reRCT), and time from the primary root canal treatment (pRCT) were assessed as cumulative factors. Descriptive and logistic regression analyses were used to identify risk factors for VRF. Receiver operating characteristic curves were constructed, and the corresponding area under the curve (AUC) was used to determine the model as a diagnostic tool.Results“Excessive” category at both pericervical and apical dentine was more frequently observed in teeth with VRF (81.8%; 36/44, 61.4%; 27/44) than in the control group (65.2%; 60/92, 10.9%; 10/92). Residual apical dentine, tooth type, history of reRCT, and time from pRCT ≥ 15 years were significantly associated with VRF in the multiple binary logistic regression analyses (p < 0.05).ConclusionsSuccessful pRCT with minimum canal preparation, particularly at the apical level, is essential to minimize the likelihood of VRF. In ETMs with an isolated periodontal probing depth ≥ 5 mm, assessing residual apical dentine, tooth type, reRCT history, and time since pRCT can effectively differentiate VRF from non‐VRF teeth (AUC, 0.940; p < 0.001), offering valuable diagnostic guidance.

Background/Objectives: Vertical root fractures (VRFs) present significant diagnostic challenges due to their subtle radiographic features and variability across imaging modalities. Artificial intelligence (AI) offers potential to improve detection accuracy, yet evidence regarding its performance across different imaging systems remains fragmented. To critically evaluate current evidence on AI-assisted detection of VRFs across periapical radiography, panoramic radiography, and cone-beam computed tomography (CBCT) and to compare diagnostic performance, methodological strengths, and limitations. Methods: A systematic review of literature up to January 2025 was carried out using databases such as PubMed, Scopus, Web of Science, and the Cochrane Library. The studies included in this review utilized AI-based techniques for detecting VRF through periapical, panoramic, or CBCT imaging. Extracted data encompassed study design, AI models, dataset sizes, preprocessing methods, imaging parameters, validation techniques, and diagnostic metrics. The risk of bias in these studies was evaluated using the QUADAS-2 tool. Results: Ten studies met inclusion criteria; CNN-based models predominated, with performance highly dependent on imaging modality. CBCT-based AI systems achieved the highest diagnostic accuracy (91.4–97.8%) and specificity (90.7–100%), followed by periapical radiography models with accuracies up to 95.7% in controlled settings. Panoramic radiography models demonstrated lower sensitivity (0.45–0.75) but maintained high precision (0.93) in certain contexts. Most studies reported improvements over human performance, yet limitations included small datasets, heterogeneous methodologies, and risk of overfitting. Conclusions: AI-assisted VRF detection shows promising accuracy, particularly with CBCT imaging, but current evidence is constrained by methodological variability and limited clinical validation.

Introduction: Vertical root fractures present significant challenges, and most often, the affected tooth is indicated for extraction. Root canal irrigants are employed synergistically alongside filing instruments during root canal therapy. The acidic nature of such irrigants is responsible for the removal of dentin during the process of biomechanical preparation. This subsequently leads to weakening of the tooth structure, ultimately leading to the fracture of the tooth. Aim: To compare the incidence of incomplete root fractures after treatment with three different root canal irrigants- citric acid, Ethylenediaminetetraacetic acid (EDTA), Regulated Ethylenediaminetetraacetic Acid (R-EDTA at two different Potential of Hydrogen (pH) levels (5.5 and 10.5). Materials and Methods: This in-vitro research was undertaken at Manav Rachna Dental College, Faridabad, Haryana, India for a period of six months from July 2024 to December 2024. Total of 48 human mandibular lateral incisors were selected and split into six groups on the premise of application of endodontic irrigants- citric acid, EDTA, R-EDTA with a particular pH. The irrigants employed were 17% citric acid pH 10.5 (Group 1), 17% citric acid pH 5.5 (Group 2), 17% R-EDTA pH 10.5 (Group 3), 17% R-EDTA pH 5.5 (Group 4),17% EDTA pH 10.5 (Group 5) and 17% EDTA pH 5.5 (Group 6). The samples were then subjected to Oil Red O Stain and analysed under a microscope for fractures. The data obtained was subjected to a Chi-squared test. Results: While no significant statistical differences were found between treatment groups (p-value&gt;0.05), a trend was observed where lower pH formulations demonstrated more fractures compared to higher pH formulations of the same irrigant. The group treated with 17% REDTA at pH 5.5 showed the highest number of tooth fractures. Conclusion: Lowering of pH might have a role in causation of incomplete root fractures. Further analysis is required to assess the impact of R-EDTA on the structural integrity of teeth.

BackgroundThis study aimed to evaluate the role of periodontal endoscopy in clinical decision-making for teeth with suspected vertical root fracture (S-VRF) and to assess the diagnostic accuracy of this procedure with respect to vertical root fracture (VRF).MethodsA prospective cohort of 115 S-VRFs meeting the inclusion criteria was analysed. The teeth were independently evaluated by two endodontists and subsequently categorized into three groups based on the type of pre-endoscopic treatment: flap surgery (S group, n = 56), endodontic treatment (R group, n = 48), and extraction (E group, n = 11). Periodontal endoscopic examination was performed for all the teeth, and treatment plans were reassigned based on findings. The diagnosis of VRF was confirmed by intraoperative crack identification or clinical failure within a 1-year follow-up period. Three cases were excluded because they were lost to follow-up.ResultsCompared with cone-beam computed tomography(CBCT), periodontal endoscopy was associated with a reduction in unnecessary nonsurgical treatment by 39.58% (19/48), reduced the incidence of unnecessary surgical treatment by 64.28% (36/56), and an increase in diagnostic accuracy by 49.1%.The sensitivity of periodontal endoscopy for VRF detection was 84.3%.ConclusionsPeriodontal endoscopy may enhanced clinical decision-making and was associated with a reduced incidence of unnecessary nonsurgical and surgical interventions in patients with S-VRFs.

Background/Objectives: The clinical outcome of root canal treatments using calcium silicate-based sealer (CSBS) remains unclear. This study aimed to evaluate the 1-year effect of CSBS in combination with a single-cone obturation technique on periapical lesion (PL) healing evaluated on cone beam computed tomography scans (CBCT) after single-visit root canal retreatment. Methods: This randomized clinical study involved 50 patients with chronic apical periodontitis and previous root canal treatment (ClinicalTrials.gov ID: NCT04072926). The inclusion criteria were previous endodontic treatment, asymptomatic inadequate endodontic treatment, PLs measuring > 5 mm, and percussion and palpation sensitivity. The exclusion criteria were immunocompromised status, pregnancy, periodontally compromised teeth, vertical root fracture, and antibiotic usage in the last month. Single-visit root canal retreatment was performed by the same endodontist. The patients were randomly divided into two groups based on the root canal sealer used: CSBS (BioRoot RCS) and epoxy resin-based sealer (ERBS) (AH Plus). Periapical healing, as the primary outcome measure, was determined according to the reduction in PL volume on CBCT from the preoperative period to the 1-year postoperative period. Results: Pre- and postoperative PL volumes (p > 0.05) were not significantly different between the CSBS and ERBS groups. The success rate (loose criteria) was 82.9% in the ERBS group and 94.7% in CSBS group. Conclusions: Root canal retreatment outcomes of CSBS, including periapical healing, are comparable to those of ERBS at 1 year after the retreatment.

Objective: This study aimed to evaluate the diagnostic accuracy of two cone beam computed tomography (CBCT) devices using 18 imaging modalities in detecting root fractures—vertical, horizontal, and oblique—in teeth with intracanal post systems. Materials and methods: Ninety-six were extracted; single-rooted mandibular premolars were endodontically treated and restored with Bundle, Reforpost, or Splendor Single Adjustable posts. Controlled fractures of different types were induced using a universal testing machine. Each tooth was scanned with NewTom 7G and NewTom Go (Quantitative Radiology, Verona, Italy) under nine imaging protocols per device; varying in dose and voxel size, yielding 1728 CBCT images. Three observers (a professor of endodontics; a specialist; and a postgraduate student in endodontics) independently evaluated the images. Results: Observers demonstrated almost perfect agreement (κ ≥ 0.81) with the gold standard in fracture detection using NewTom 7G. No significant differences were found in sensitivity, specificity, or accuracy across voxel size and dose parameters for both devices in detecting fracture presence (p > 0.05). Similarly, both devices displayed comparable performance in identifying horizontal and oblique fractures (p > 0.05). However, in NewTom Go, regular and low doses with different voxel sizes showed reduced sensitivity and accuracy in detecting vertical fractures across all post systems (p ≤ 0.05). Conclusions: NewTom 7G, with its advanced detector system and smaller voxel sizes, provides superior diagnostic accuracy for root fractures. In contrast, NewTom Go displays reduced sensitivity for vertical fractures at lower settings. Clinical relevance: CBCT device selection and imaging protocols significantly affect the diagnosis of vertical root fractures.

Introduction: Nickel-titanium (Ni-Ti) instrumentation systems have been extensively studied for their clinical performance; however, limited evidence exists regarding their effect on the resistance of endodontically treated teeth to vertical root fractures (VRFs). This investigation aimed to assess and compare the VRF resistance of teeth prepared using various root canal instrumentation methods.Methods: An a priori power analysis was performed to determine the required sample size. Seventy extracted human mandibular premolars were decoronated and assigned to one control and four experimental groups: Hand instrumentation using hand K-files (Dentsply Maillefer, Ballaigues, Switzerland), rotary instrumentation using ProTaper NEXT (Dentsply Sirona, Ballaigues, Switzerland), reciprocation WaveOne Gold (Dentsply Sirona, Ballaigues, Switzerland), and a hybrid technique, a combination of ProTaper Universal (Dentsply Sirona, Ballaigues, Switzerland) with hand K-file (Dentsply Maillefer, Ballaigues, Switzerland). Root canals were shaped and filled following each system's protocol, except in the control group. All specimens were mounted in acrylic resin and subjected to vertical fracture testing using a universal loading machine (Shanta Engineering, Maharashtra, India).Results: The control group exhibited the greatest resistance to VRFs (271 ± 65.7 N). Among the instrumented groups, the hand K-file group demonstrated the highest resistance (221.33 ± 58.8 N), whereas the WaveOne Gold group showed the lowest resistance (189.33 ± 47.9 N). A statistically significant difference was observed between the control and experimental groups (p = 0.004).Conclusion: Instrumentation using hand K-files preserved more dentinal structure, resulting in greater fracture resistance. Conversely, WaveOne Gold preparation was associated with reduced VRF resistance compared to the other techniques.

Diagnosis of In Vivo Vertical Root Fracture in Endodontically Treated Teeth Using Machine Learning Techniques.

Endodontic Microsurgery On Vertical Root Fracture With 24-Month Review

Cemental Tear: Systematic Review and Thematic Analysis of Clinical and Imaging Features with a Proposed Diagnostic Framework.

Cone-beam computed tomography (CBCT) has emerged as a pivotal imaging modality in dentistry, offering three-dimensional visualization with high spatial resolution and flexible parameter settings. Compared with conventional two-dimensional radiographs, CBCT enables detailed assessment of tooth fractures by optimizing voxel size, field of view, and exposure parameters, thereby balancing diagnostic precision with radiation safety. Iterative reconstruction and deep learning-based algorithms further enhance image quality, suppress artifacts, and improve the visualization of subtle fracture lines. Clinically, CBCT provides valuable diagnostic insights for crown fractures, root fractures, cracked teeth, and vertical root fractures, particularly when traditional radiographs are insufficient. It allows accurate evaluation of fracture depth, orientation, and anatomical relationships, while also supporting treatment planning in oral surgery, implantology, and orthodontics. Integration with artificial intelligence holds promise for automated crack detection, image enhancement, and workflow digitalization, significantly reducing operator dependence and diagnostic variability. This review aims to summarize the application value and technical advantages of CBCT in diagnosing various types of tooth fractures, to discuss advances in parameter optimization, artifact reduction, and AI-assisted analysis, and to highlight its limitations and future directions toward standardized and precise clinical practice.

Cemental tear is a rare and indetectable condition unless obvious clinical signs present with the involvement of surrounding periodontal and periapical tissues. Due to its clinical manifestations similar to common dental issues, such as vertical root fracture, primary endodontic diseases, and periodontal diseases, as well as the low awareness of cemental tear for clinicians, misdiagnosis often occurs. The critical principle for cemental tear treatment is to remove torn fragments, and overlooking fragments leads to futile therapy, which could deteriorate the conditions of the affected teeth. Therefore, accurate diagnosis and subsequent appropriate interventions are vital for managing cemental tear. Novel diagnostic tools, including cone-beam computed tomography (CBCT), microscopes, and enamel matrix derivatives, have improved early detection and management, enhancing tooth retention. The implementation of standardized diagnostic criteria and treatment protocols, combined with improved clinical awareness among dental professionals, serves to mitigate risks of diagnostic errors and suboptimal therapeutic interventions. This expert consensus reviewed the epidemiology, pathogenesis, potential predisposing factors, clinical manifestations, diagnosis, differential diagnosis, treatment, and prognosis of cemental tear, aiming to provide a clinical guideline and facilitate clinicians to have a better understanding of cemental tear.

Vertical root fracture (VRF) often occurs in endodontically treated teeth. Root canal therapy (RCT) requires removal of part of the dentin, which affects the microhardness and elastic modulus of dentine, induces dentin microcracks, and increases the risk of VRF. The early diagnosis of VRF is challenging and the prognosis is poor, due to the absence of specific clinical manifestations. This narrative review analyzes the incidence and related factors of VRF after RCT from the perspective of etiology, discusses the effect and mechanism of each step during RCT on the occurrence of VRF, and briefly summarizes the diagnosis, prevention and treatment strategies of VRF, so as to reduce the occurrence of VRF and improve the prognosis of endodontically treated teeth.

Prevalence of Vertical Root Fractures in Root Filled Teeth and Their Clinical and Radiographic Risk Factors: A Modern Case-Control Analysis Based on Surgical Diagnosis.

Introduction: The present study evaluated the clinical and patient-centered outcomes of nonsurgical retreatment of endodontically treated teeth. The primary goal was to assess the success rate, defined by clinical and radiographic criteria, while the secondary objectives focused on patient-reported quality-of-life outcomes using a validated oral health-related quality-of-life (OHRQoL) questionnaire.Materials and methods: This prospective cohort study was conducted from January 2024 to April 2025 at the Department of Conservative Dentistry and Endodontics and included 100 systemically healthy adults (aged 18-60 years) requiring retreatment of endodontically treated teeth. Patients with vertical root fractures, advanced periodontal disease, or non-restorable teeth were excluded. The procedure was performed using current/contemporary endodontic technologies such as rotary files, ultrasonic irrigation, and warm vertical compaction with gutta-percha and root canal sealer. Calcium hydroxide was used as an intracanal medication between visits. Outcomes were assessed six months after permanent restoration via clinical examinations and digital periapical radiographs, categorizing cases as healed, healing, or non-healing. OHRQoL scores were collected preoperatively and one- and six-months post-treatment using a modified questionnaire with a 1-5 Likert scale. Statistical analyses included Friedman’s test for OHRQoL scores and Fisher’s exact test for success rates with a significance level of p < 0.05.Results: Of 100 patients, 88 (88%) patients achieved successful outcomes (healed, healing, or non-healing). Maxillary jaw retreatments outperformed mandibular jaw retreatments, and cases with periapical lesions had higher success rates than those without periapical lesions. No demographic or clinical factor significantly influenced the success rate (p > 0.05). Successful cases showed significant OHRQoL improvement (p = 0.001) from baseline (32.13 ± 12.07) to six months (19.40 ± 12.07), while failed cases showed no significant change (p = 0.425).Conclusion: Nonsurgical root canal retreatment in endodontically treated teeth achieved a high success rate with significant quality-of-life improvements in successful cases, underscoring the efficacy of standardized protocols and advanced technologies.

Background: Post-treatment disease after non-surgical root canal treatment remains clinically consequential, and reported reasons for failure of endodontically treated teeth vary across studies due to differing endpoints and categorization schemes. Objective: To identify the reasons for failure of endodontically treated teeth presenting with post-treatment disease and to evaluate associations with patient- and tooth-related factors. Methods: A cross-sectional study conducted from April 2019 To December 2022, assessed endodontically treated teeth with periapical radiolucency and/or symptoms in the outpatient departments of two teaching hospitals in Islamabad. Two calibrated operators performed standardized clinical and periapical radiographic evaluations and assigned a single primary failure reason using a predefined categorization framework (8). Frequencies and percentages were calculated, and associations between failure categories and age group and gender were evaluated using chi-square testing. Results: In the analytical dataset (n=374), endodontic reasons were most frequent (58.6%, n=219), followed by combined endodontic and restorative reasons (24.3%, n=91). Restorative reasons (5.6%), vertical root fracture (5.1%), endodontic failure despite apparently adequate treatment (3.7%), and non-restorable caries/cuspal fracture (2.7%) were less common, while periodontal, prosthetic, and orthodontic reasons were not observed. Failure was more frequently represented in mandibular teeth (64.7%) than maxillary teeth (35.3%), with mandibular molars most commonly affected (53.2%). Conclusion: Endodontic technical reasons predominated among failing endodontically treated teeth in this OPD-based cohort, and mandibular molars were most frequently represented, supporting the importance of technical endodontic quality and definitive coronal sailing.

This report describes a clinical case involving a minimally traumatic tooth extraction followed by immediate implant placement in the region of an upper premolar, associated with alveolar grafting using a synthetic biomaterial and an autogenous graft harvested from the maxillary tuberosity. A 38-year-old male patient presented with a vertical root fracture in tooth 25. Atraumatic extraction was performed, followed by alveolar curettage and immediate placement of a conical implant (Ø 3.5 × 13 mm). The buccal gap was filled with hydroxyapatite combined with β-tricalcium phosphate and autogenous bone graft obtained from the maxillary tuberosity. An immediate provisional acrylic resin crown was installed with occlusion deactivated. After six months, a definitive zirconia crown with a lithium disilicate infrastructure was fabricated and cemented. Immediate post-extraction implant placement has emerged as an effective treatment strategy, particularly in esthetic zones, allowing for preservation of bone and gingival architecture, reduction of physiological resorption, and enhanced esthetic predictability. The immediate approach, when combined with biomaterials and autogenous grafts, proved to be effective for both functional and esthetic rehabilitation in this case, ensuring preservation of peri-implant tissues and yielding an excellent clinical outcome.

BackgroundThe study aimed to investigate the furcation groove’s (FG) prevalence, depth, length and associated dentin thickness (DT) in Maxillary First Permanent Premolars (MFPM’s) in Saudi Sub-population.MethodsThe study was a cross-sectional study, conducted at Qassim University, KSA, on 156 CBCT images. The presence of FG, its length, depth, and associated DT at the deepest point were recorded. Measurements were performed independently by two calibrated examiners. Statistical analysis was conducted using SPSS 26, with chi-square tests applied to assess gender- and quadrant-wise differences. The significance level for this study was set to be p < 0.05.ResultsAmong the studied MFPMs, 71% exhibited FGs on the palatal facet of the buccal root. The mean FG length was 4.16 mm, mean FG depth was 0.56 mm, and mean DT at the deepest point was 0.82 mm. No significant differences were found in FG prevalence based on gender or quadrant. Most grooves were located at the furcation level (75.8%), while the remaining were found below (16.7%) or before (7.5%) the furcation. Correlation analysis revealed a weak negative association between groove depth and dentin thickness (ρ = -0.180, p = 0.049). Multivariable ordinal regression identified male gender as the primary predictor of higher dentin thickness risk categories (OR = 5.12, p < 0.001), while groove morphometric parameters were not significant predictors.ConclusionsThe high prevalence of FG in MFPMs and its significant association with reduced DT highlight its clinical importance. These anatomical features increase the risk of complications during endodontic treatment (ET), including strip perforations and vertical root fractures. In order to identify at-risk areas, preoperative CBCT evaluation is essential as this allows for modified treatment strategies to preserve root integrity and improve ET outcomes.

This review highlights the potential of artificial intelligence algorithms, including machine learning (ML) and deep learning (DL), in improving the diagnosis and management of oral and maxillofacial diseases through advanced imaging techniques such as computerized tomography (CT) and cone-beam computed tomography (CBCT). The current review was conducted on the basis of ISI Web of Science, PubMed, Scopus, and Google Scholar (2010-2024) using keywords related to radiography, MRI, CT, CBCT, ML, DL, and maxillofacial pathology, with a focus on clinical applications. The DL algorithms for detecting vertical root fractures achieved a diagnostic accuracy of 89.0% for premolars, with a sensitivity of 84.0% and specificity of 94.0%. It demonstrated an accuracy of 93% and a specificity of 88% in evaluating CBCT images. The GoogLeNet Inception v3 architecture achieved an AUC of 0.914, sensitivity of 96.1%, and specificity of 77.1% for CBCT, outperforming the panoramic radiograph, which had an AUC of 0.847, sensitivity of 88.2%, and specificity of 77.0%. CBCT demonstrated higher diagnostic accuracy (91.4%) than panoramic images (84.6%), with odontogenic cystic lesions exhibiting the highest accuracy. The U-Net-based DL algorithm achieves recall, precision, and F1 scores of 0.742, 0.942, and 0.831 for metastatic lymph nodes, and 0.782, 0.990, and 0.874 for nonmetastatic lymph nodes, respectively. This study highlights the superior anatomical detail of CBCT, making it more reliable for diagnosing oral and dentomaxillofacial disorders. DL algorithms demonstrate high accuracy and sensitivity in diagnosing dental and odontogenic disorders and often outperform radiologists.

BackgroundReattachment of root fragments with appropriate adhesive materials is expected to be the last conservative treatment for preserving teeth with vertical root fractures (VRFs).ObjectiveThis study evaluated the biocompatibility of 4-META/MMA-TBB resin for root repair, compared with iRoot BP Plus, Fuji IX GIC, and Clearfil SA Luting. Fracture resistance and microleakage of the reattached roots were also tested.MethodsThe biocompatibility of set materials was evaluated on L929 fibroblasts. Cell Counting Kit-8 (CCK-8) assay, live/dead cells staining and flow cytometry were used to assess cell biocompatibility. VRFs were created in bovine teeth, which were then reattached with set materials (excluding iRoot BP Plus). For the fracture resistance test, the roots were vertically fractured through the root canals (n = 20). The fracture resistance was compared with sound roots (control group) and fracture patterns were observed under a microscope. Microleakage was also tested on the reattached roots (n = 10). Results were analyzed by one-way ANOVA and the Tukey test. The significance level was set at α = 0.05.ResultsClearfil SA Luting group exhibited the highest cytotoxicity. The other test materials had acceptable cytotoxicity, not exceeding Grade 1 [relative growth ratio (RGR) &amp;gt; 75%] in CCK-8. Flow cytometry showed that the proportion of viable cells exposed to 4-META/MMA-TBB resin displayed no significant difference compared with iRoot BP Plus (P &amp;gt; 0.05). The root fracture resistances reattached using 4-META/MMA-TBB resin and Clearfil SA Luting were higher than that by Fuji IX GIC, but lower than those of the control group (P &amp;lt; 0.05). The difference between the two resin groups was statistically insignificant (P &amp;gt; 0.05). As for the microleakage, 4-META/MMA-TBB resin group had the shortest penetration depth, whereas Fuji IX GIC group showed the longest penetration (P &amp;lt; 0.05).Conclusions4-META/MMA-TBB resin had acceptable cell biocompatibility for root repair, similar to iRoot BP Plus. It can provide good fracture resistance and excellent sealing effect for reattaching treatment of VRFs.