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Vertical root fractures represent between 2 and 5 percent of crown/root fractures. The greatest incidence occurs in endodontically treated teeth, and in patients older than 40 years of age. The occurrence of a complete vertical root fracture is often catastrophic for the individual tooth as tooth extraction is usually the only reasonable treatment.
Root fracture of the tooth is a dentine cementum fracture involving the pulp. Traumatic root fracture occurs most often in the middle third of the roots of fully erupted and fully formed teeth. However, root treated teeth are more susceptible to root fracture, as this involves removing root dentine, thereby weakening the tooth.
In the dental specialty of endodontics, periradicular surgery is surgery to the external root surface. Examples of periradicular surgery include apicoectomy, root resection, repair of root perforation or resorption defects, removal of broken fragments of the tooth or a filling material, and exploratory surgery to look for root fractures.
Typically the tooth is lifted using an elevator, and using dental forceps, specific tooth movements are performed (e.g. rocking the tooth back and forth) expanding the tooth socket. Once the periodontal ligament is broken and the supporting alveolar bone has been adequately widened the tooth can be removed.
No treatment is needed if it is asymptomatic. Treatment options will be extraction for symptomatic primary tooth. For symptomatic permanent tooth, root canal treatment is often challenging because the pulp chamber is filled with calcified material and the drop-off sensation of entering a pulp chamber will not occur. [44]
Tooth #5, the upper right second premolar, after extraction. The two single-headed arrows point to the CEJ, which is the line separating the crown (in this case, heavily decayed) and the roots. The double headed arrow (bottom right) shows the extent of the abscess that surrounds the apex of the palatal root.