| A vertical root fracture is a longitudinally oriented fracture of the root. It can extend from one external surface to the other and include a portion of the root canal space or limit itself to one side and not cross the root canal line. It is not infrequently encountered by oral clinicians , though the definite cause is unclear. The patient may be asymptomatic, but a definite diagnosis is essential to avoid inappropriate treatment. However, it is often difficult to reach an accurate diagnosis on the basis of the presenting symptoms and signs because these clinical features are variable or nonspecific .Conventional periapical radiographs can be helpful for the diagnosis. When the X-ray beam is parallel to the plane of the fracture, but that is not likely to occur most of the time. Because periapical radiographs are two-dimensional (2D) images of three dimensional anatomic structures , the superimposition of adjacent tissues may obscure the visibility of VRF .Cone beam computer tomography (CBCT) scans, which provide high-resolution images in three planes at reduced dose and costs, is now used in the diagnosis of VRF. Despite the above mentioned advantages, a comprehensive analysis of the value of CBCT images in the diagnosis of VRF needs to be performed.This was a retrospective study in which we reviewed patients with VRF and the aim was to study the application of CBCT for the diagnosis of VRF. Moreover, the value of CBCT in the detection of VRF relative to the value of conventional periapical radiographs was studied.This study includes three parts:1.Aim: The aim was to study the clinical features of two groups(vertical root fracture in nonendodontically treated teeth and vertical root fracture in endodontically treated teeth) and other factors such as age, gender . Methods: We reviewed 139 patients with 156 teeth in which VRF was diagnosed. Age from 20 to 89.These cases were divided into two groups: vertical root fracture in nonendodontically treated teeth and vertical root fracture in endodontically treated teeth. Results: VRF occurs more often in molars .The symptom of VRF in nonendodontically treated teeth was pain on mastication or toothache. Clinical features such as pain, sensitive to percussion(94.6%), responsive to pulp vitality testing(89.1%). Periodontal examination disclosed a pocket on the surface of the tooth(88.0%). The symptoms of VRF in endodontically treated teeth was mostly mild pain or discomfort. Clinical features involve sensitive to percussion(40.6%) ,periodontal examination disclosed a pocket on the surface of the tooth. Conclusions: The causes of VRF are more complex. Two groups are differences in clinical symptoms and signs.2.Aim: The aim was to evaluate the usefulness of cone beam computer tomography (CBCT) for detection of VRF .Methods : We examined 150 patients with a total of 161 teeth by CBCT for determining whether they had a vertical root fracture. The patient characteristics were recorded, and the location, fractured roots, and the related skeletal structures of the involved teeth were analyzed. Two experienced endodontists independently analyzed each case. Each diagnosis was classified into two categories: fracture definitely present(FDP),fracture definitely not present(,FDNP),then compared with the diagnostic criteria. Results:59.6% of the 161 teeth was diagnosed as FDP. VRF occur in intraoperative findings and extracted teeth . During follow-up, 10 of the 65 teeth diagnosed as FDNP were proven to be fractured. Conclusions:The application of CBCT is valuable for the diagnosis of vertical root fracture.3.Aim :To compare the diagnostic potential of cone-beam computed tomography (CBCT) with conventional periapical radiographs (PR) for detecting vertical root fractures (VRFs). Methods: Sixty-nine patients with 84 teeth in which vertical root fracture was clinically suspected underwent periapical radiographs and CBCT. Two experienced endodontists independently analyzed each case and reached a consensus diagnose. The results were compared with intraoperative findings and analyzed statistically. Results :The positive rate,sensitivity and accuracy for VRFs of CBCT were 82.1%,87.3%,88.1%.For that of PRs ,the value were39.3%,41.8%,45.2%,respectively with significant difference (P<0.001).Conclusions: CBCT is superior to periapical radiographs in the detection of vertical root fractures. |
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