Vertical root fracture: Factors related to identification
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- 作者：Richard E. Walton ; DMD ; MS ; Richard-walton@uiowa.eduAuthor Vitae
- 关键词：Diagnosis ; tooth ; fracture ; endodontics
- 刊名：The Journal of the American Dental Association
- 出版年：2017
- 出版时间：February 2017
- 年：2017
- 卷：148
- 期：2
- 页码：100-105
- 全文大小：1294 K
- 卷排序：148
文摘
Vertical root fracture (VRF) requires root removal. Diagnostics for proper identification are critical. The author conducted a study to relate subjective, objective, and radiographic findings for VRF identification. They noted visual changes of root and overlying bone patterns after flap reflection.MethodsThe author examined a case series of roots with suspected VRF after flap reflection and root or root-end removal; 42 roots were identified with a fracture. Before reflection, the author obtained diagnostic and periapical radiographic data that included symptoms, soft-tissue changes, percussion, mobility, probing patterns, and radiographic findings. After flap reflection, the author evaluated bony changes and root surfaces. VRF was visually confirmed after tooth or root removal.ResultsSigns and symptoms diagnostic of VRF were inconsistent. All patients had endodontic therapy, many with posts, and for all patients, the pain was none to mild. In addition, the author found a history or presence of swelling (77%) or sinus tract (31%), that probing patterns differed (narrow-rectangular 66%), and that there was no defect in some patients (21%). Radiographic patterns varied from no change to extensive bone loss, and mobility ranged from none (55%) to slight or moderate (45%). Flap reflection revealed a “punched-out” bony lesion with granulomatous tissue (100%), and patterns were fenestration (21%) or dehiscence (79%). A fracture was visible on roots or resected root ends.ConclusionsThe author found no consistent signs, symptoms, or radiographic changes of VRF. Flap reflection was found to be predictably useful; fractured roots had bony defects filled with granulomatous tissue.Practical ImplicationsVRF may be suspected from clinical findings; however, flap reflection is usually required for identification. Characteristic bony pattern and root visualization reveals the fracture, although root-end resection and examination is occasionally required.