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LETTER TO THE EDITOR
Year : 2013  |  Volume : 2  |  Issue : 4  |  Page : 307-309

Management of vertically fractured endodontically treated molars


1 Department of Conservative Dentistry and Endodontics, SIBAR Institute of Dental Sciences, Guntur, Andhra Pradesh, India
2 Department of Conservative Dentistry and Endodontics, St. Joseph Dental College, Eluru, Andhra Pradesh, India

Date of Web Publication26-Nov-2013

Correspondence Address:
Pragna Mandava
Department of Conservative Dentistry and Endodontics, SIBAR Institute of Dental Sciences, Takellapadu, Guntur-522 509, Andhra Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2277-8632.122184

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How to cite this article:
Mandava P, Vemuri S, Bolla N, Kavuri SR. Management of vertically fractured endodontically treated molars. J NTR Univ Health Sci 2013;2:307-9

How to cite this URL:
Mandava P, Vemuri S, Bolla N, Kavuri SR. Management of vertically fractured endodontically treated molars. J NTR Univ Health Sci [serial online] 2013 [cited 2020 Jul 10];2:307-9. Available from: http://www.jdrntruhs.org/text.asp?2013/2/4/307/122184

Sir,

A vertical fracture manifests as a complete or incomplete fracture line extending obliquely or longitudinally through the enamel and dentin of an endodontically treated root. [1] Although several methods have been used to treat vertically fractured teeth, ranging from extraction to preservation of the tooth by procedures like premolarization, removal of one fractured fragment and giving crown on rest of the tooth, and approximation of both the fragments by means of adhesive cement; no specific treatment modality has been established. Here are two case reports discussing the management of vertically fractured endodontically treated molars.


  Case Report 1 Top


A 40-year-old male patient reported to the Department of Conservative Dentistry and Endodontics with chief complaint of discomfort in left upper back tooth region since 1 day. History revealed that he had root canal therapy for the same tooth 20 days back. Radiographs were taken at different angulations, but the fracture line was not appreciated. Examination with tooth sloth showed a vertical fracture in crown of left maxillary first molar mesiodistally. The case was diagnosed as a vertical coronal fracture running mesiodistally confined to the crown of the tooth.

The tooth was immediately adjusted out of occlusion. The access cavity filling material is removed and the fracture was observed to extend up to the cement enamel junction. Both buccal and lingual fragments are approximated by means of intracoronal splints, that is, two vertical grooves were created in buccopalatal direction such that they extended 1 mm short of the buccal and lingual external tooth surface as this part would be removed during the crown preparation. Later, two H files fragments which corresponded to the grooves placed, were luted in place with composite resin. These fragments acted as reinforcing agents which prevented the separation of the fragments under masticatory forces. Later, at the tissue surface of the fracture fragments a groove was created with chamfer diamond point, the interface between the fragments is restored with mineral trioxide aggregate (MTA) [Figure 1], and moist cotton pellet is placed and the access cavity is restored with Cavit and the tooth is left undisturbed for 24 h.
Figure 1: H files reinforcing the fragments and mineral trioxide aggregate (MTA) placed

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On second visit, after confirming that MTA is set, the access cavity is restored with composite resin and tooth preparation was done with support of rubber dam clamp and metal ceramic crown was placed. The patient was evaluated after 3 months, 6 months, and 1 year [Figure 2].
Figure 2: One year follow-up radiograph of case 1

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  Case Report 2 Top


A 35-year-old male patient reported with a chief complain of pain in right lower back tooth region upon biting since 2 days. The history was taken and the tooth was endodontically treated 2 months back. Examination revealed that the tooth was fractured buccolingually in relation to tooth #36. Same treatment procedure as described for above case has been followed, that is, intracoronal splint placement in mesiodistal direction, placement of MTA at the prepared interface of fragments, restoration with composite, and placement of metal ceramic crown. The patient was reviewed for 2 years. The tooth was clinically and radiographically sound [Figure 3].
Figure 3: Two year follow-up radiograph of case 2

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Various reasons for vertical fractures are excessive root canal preparation, overzealous lateral and vertical compaction forces during root canal filling, moisture loss in pulpless teeth, overpreparation of post space, excessive pressure during post placement, and compromised tooth integrity as a result of large carious lesions or trauma. [1] For maxillary molars, fracture line extending mesiodistally and for mandibular molars, the fracture extending buccolingually are having good prognosis. [2] Postendodontic restoration is a critical final step of successful endodontic therapy in these cases because the presence of fracture lines or cracks sometimes may even cause failure of the root canal treatment. [3] Supracrestal fractures are having better prognosis than infracrestal fractures. Fractures not in the line of long axis of roots are having better prognosis than those within the root in multirooted teeth.

The more centered the fracture is occlusally, the greater the tendency to extend apically. These fractures are more devastating. Mobility of one or both segments will be present. Maintaining an intact tooth is challenging if not impossible. [4] Prognosis is variable. Immediate reporting of the patients and proper diagnosis without delay; provision of prompt treatement, that is, following strict aseptic technique; and usage of biocompatible material (MTA) for repair along the tissue surface of fracture also played a key role in the success of these cases.

 
  References Top

1.Özer SY, Ünlü G, Deðer Y. Diagnosis and treatment of endodontically treated teeth with vertical Root fracture: Three case reports with two-year follow-up J Endod 2011;37:97-102.  Back to cited text no. 1
    
2.Pollyanna Queiroz Freitas a Paulo Maria Santos Rabêlo-Júnior, Claúdia Maria Coelho Alves cSoraia de Fatima Carvalho Souza. The diagnostic challenge of vertical root fracture in endodontically treated teeth: A case report Rev Odonto Cienc 2012;27:82-6.  Back to cited text no. 2
    
3.Kathuria A, Kavitha M, Ravishankar P. An innovative approach for management of vertical coronal fracture in molar: Case report Case Rep Dent 2012;21:1-4.  Back to cited text no. 3
    
4.Jyothi KN. Management of vertically fractured maxillary second molar. J Dent Sci Res 2010;1:45-50.  Back to cited text no. 4
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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