Vertical Root Fractures in Endodontic Practice

Shahrzad Rahimi

Alte University

Department of Dentistry

Course Name: Academic Writing

Tharaka Dunuwila

Due Date: 24th December 2023

 Introduction

Vertical root fractures (VRFs) are among the most challenging complications in endodontic

practice, frequently resulting in tooth extraction or amputation. These fractures, often undetectable

until they become symptomatic, pose a significant threat to the longevity of endodontically treated

teeth. Traditionally, VRFs have been considered an epidemic within the field of dentistry, prompting a

reevaluation of clinical practices, including modifications in access openings and alterations in

preparation and disinfection protocols during endodontic treatments (Rivera & Walton, 2015; Clark &

Khademi, 2010).

The surge in VRF incidents, especially noted during the COVID-19 pandemic, has further

emphasized the need for a comprehensive understanding of their prevalence, etiology, and

management. This pandemic period not only posed challenges to dental health services but also brought

to light the adaptability and resilience required in dental practice. The present essay seeks to analyze

the prevalence of VRFs by examining data from both a University Endodontic Program (UEP) and a

private practice (PP), exploring the changes in prevalence during the COVID-19 pandemic, and discussing

alterations in the frequency of cases diagnosed through clinical and radiographic signs.

Discussion

Prevalence and Impact of COVID-19

The prevalence of VRFs has seen a notable increase during the COVID-19 pandemic. This rise can

be attributed to various factors, including stress-related bruxism and changes in dental care access

during the pandemic (Augusto et al., 2020; von Arx, Maldonado, & Bornstein, 2021). The increased

prevalence underscores the importance of understanding the etiology and management of VRFs in

changing health landscapes.

Diagnostic Challenges

Diagnosing VRFs remains a complex task, with challenges heightened by the subtlety of

symptoms and their similarity to other dental issues. Technologies like high-resolution small-volume

cone-beam computed tomography have been explored for their accuracy in VRF diagnosis, though they

have limitations (Dias et al., 2020). The clinical signs in bruxer patients, such as deep periodontal pockets

and gingival swelling, are crucial for diagnosis, emphasizing the need for comprehensive examination

(von Arx & Bosshardt, 2017).

Management and Prevention Strategies

The management of VRFs often involves tooth extraction, highlighting the need for preventive

strategies. Understanding the factors that contribute to VRFs, such as the loss of coronal tooth

structure, is vital in both prevention and treatment (Al-Nuaimi et al., 2017). The design of endodontic

access cavities and the minimization of root canal tapering are crucial in maintaining tooth integrity and

preventing fractures (Barbosa et al., 2020; Cavalcante et al., 2020). Additionally, the role of post-

endodontic restoration methods, like conservative post-and-core techniques, is essential in preventing

further structural compromise (Naumann, Schmitter, & Krastl, 2018; Arias & Peters, 2022)

Conclusion

The exploration into vertical root fractures (VRFs) in endodontic practice has highlighted their

multifaceted nature, encompassing challenges in diagnosis, management, and treatment outcomes. The

COVID-19 pandemic has notably influenced the prevalence of VRFs, underscoring the need for

adaptability in dental practices during such global health crises (Augusto et al., 2020; von Arx,

Maldonado, & Bornstein, 2021).

 Diagnosing VRFs remains a complex endeavor, with technologies like high-resolution small-

volume cone-beam computed tomography providing some diagnostic insights, despite limitations (Dias

et al., 2020). The management of VRFs often culminates in extraction, especially in single-rooted teeth,

emphasizing the importance of preventive strategies and the need to understand predisposing factors

(Al-Nuaimi et al., 2017; von Arx & Bosshardt, 2017).

Preventive measures, including the design of endodontic access cavities and the consideration

of root canal tapering, play a crucial role in maintaining tooth integrity and preventing fractures

(Barbosa et al., 2020; Cavalcante et al., 2020). Furthermore, the choice of post-endodontic restoration

methods, such as conservative post-and-core techniques, is vital for preserving the structural integrity of

the tooth (Naumann, Schmitter, & Krastl, 2018; Arias & Peters, 2022).
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