Diagnosis of Vertical Root Fractures in Restored Endodontically Treated Teeth: A Time-dependent Retrospective Cohort Study

• This study highlights the average time taken for the clinical presentation of vertical root fracture (VRFs) in endodontically treated teeth restored with crowns and without posts.
• This study highlights the association between the length of obturation and VRFs.
• This study highlights the characteristic clinical and radiographic features of VRFs in endodontically treated teeth restored with crowns and without posts.

IntroductionThe purpose of this study was to examine different patient- and treatment-related factors associated with the time of presentation of vertical root fractures (VRFs) in endodontically treated teeth restored with crowns.MethodsOne hundred ninety-seven root-filled, crowned teeth with no post and suspected of VRFs were included in the study. Patient details with relevance to endodontic treatment and clinical signs/symptoms were documented, and radiographs were taken. A diagnosis of a VRF was confirmed after surgical flap elevation. Frequency distributions were determined, and statistical analyses were performed using Pearson chi-square analysis, Fisher exact test, cross tabulation, Pearson correlation, and multiple logistic regression.ResultsMandibular molars (34%) and maxillary premolars (22.8%) were the most frequently affected teeth. The postoperative time to the diagnosis of a VRF was 4.35 (±1.96) years. Female patients, posterior teeth, overfilled canals, and patients older than 40 years were associated with the presentation of VRFs within 5 years of the postoperative period. Clinical findings most frequently observed were pain on percussion (60%), pain on palpation (62%), presence of a deep narrow pocket (81%), and sinus tract/swelling (67%). “Halo”-type radiolucency (48.7%) was the most common radiographic feature related to VRFs.ConclusionsPain on palpation/percussion, deep narrow pocket, sinus tract, and halo-type radiolucency are characteristic features of VRFs. Posterior teeth, overfilled canals, female patients, and older patients (>40 years) presenting with the previously described clinical features in endodontically treated teeth restored with crowns are more likely to present with VRFs within 5 years postoperatively.