Diagnosis and treatment of endodontically treated teeth with vertical root fracture: three case reports with two-year follow-up.

INTRODUCTION: Vertical root fracture (VRF) is an important threat to the tooth's prognosis during and after root canal treatment. Often the detection of these fractures occurs years later by using conventional periapical radiographs. However, recent studies have addressed the benefits of computed tomography to diagnose these problems earlier. Accurately diagnosed VRFs have been treated by extraction of teeth, with minimal damage to the periodontal ligament, extraoral bonding of fractured segments with an adhesive resin cement, and intentional replantation of teeth after reconstruction.
METHODS: The 3 case reports presented here describe the diagnosis and treatment of vertically fractured teeth that had been previously treated endodontically. Cone-beam computed tomography (CBCT) was used for diagnostic imaging to detect VRFs. Vertically fractured roots were carefully extracted and extraorally treated by using a self-etching dual-cure adhesive resin cement, and intentional replantations were performed after reconstruction.
RESULTS: After a mean follow-up period of 2 years, the teeth were asymptomatic. There was no clinical ankylosis, and diagnosis by using CBCT scans showed reduced periapical radiolucency.
CONCLUSIONS: Extraoral bonding of fractured segments and intentional replantation of teeth after reconstruction provide an alternative treatment to extraction, especially for anterior teeth. Computed tomography-assisted VRF diagnosis is helpful in detecting fractures; however, higher-resolution tomography units providing better image quality would be a better choice for improved visualization of these fractures.