Restor Dent Endod.  2016 Nov;41(4):316-321. 10.5395/rde.2016.41.4.316.

Microsurgical re-treatment of an endodontically treated tooth with an apically located incomplete vertical root fracture: a clinical case report

• Taschieri
• Del Fabbro M
• El Kabbaney A
• Tsesis I
• Rosen E
• Corbella S

• KMID: 2356009
• DOI: http://doi.org/10.5395/rde.2016.41.4.316

Abstract

Although it is challenging, the early diagnosis of a vertical root fracture (VRF) is crucial in order to ensure tooth preservation. The purpose of this clinical case report was to describe reparative surgery performed to treat a tooth affected by an incomplete VRF. A 26 year old male patient was suspected to have a VRF in a maxillary left central incisor, and an exploratory flap was performed in order to confirm the diagnosis. After detecting the fracture, the lesion was surgically treated, the fracture and the infected root-end were removed, and a platelet-rich plasma membrane was used to cover the defect in order to prevent bacterial migration. A 24 month clinical and radiological follow-up examination showed that the tooth was asymptomatic and that the healing process was in progress. The surgical approach described here may be considered an effective treatment for a combined endodontic-periodontal lesion originating from an incomplete VRF and a recurrent periapical lesion.

Keyword

Microsurgery; Platelet-rich plasma; Tooth fractures; Vertical root fracture

MeSH Terms

Diagnosis
Early Diagnosis
Follow-Up Studies
Humans
Incisor
Male
Membranes
Microsurgery
Platelet-Rich Plasma
Tooth Fractures
Tooth*

Figure

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  Figure 1 Clinical presentation at baseline. The presence of a sinus tract is evident.

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  Figure 2 (a) Periapical radiograph and (b, c, d, and e) cone-beam computed tomography (CBCT) sections showing the presence of a periradicular lesion. (b, c, and d) The sagittal sections show the periapical bone defect; (e) the CBCT horizontal projection demonstrates the fracture line.

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  Figure 3 After flap elevation, the presence of the lesion was clearly detectable.

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  Figure 4 Visualization of the vertical root fracture on the root.

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  Figure 5 (a) After root resection, the root canal orifice is clearly visualized (yellow), as well as the small residual fracture line (blue); (b) The root-end preparation using a piezoelectric device is shown; (c) Groove preparation following the residual fracture line; (d) Filling of the created cavity.

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  Figure 6 Radiograph taken immediately after surgery.

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  Figure 7 Results of clinical (a) and radiographic (b) examinations six months after surgery.

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  Figure 8 Results of clinical (a) and radiographic (b) examinations 24 months after surgery.

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