Diagnosis of Vertical Root Fractures in Restored Endodontically Treated Teeth: A Time-dependent Retrospective Cohort Study

Introduction: The purpose of this study was to examine different patient- and treatment-related factors associated with the time of presentation of vertical root fractures (VRFs) in endodontically treated teeth restored with crowns. Methods: One hundred ninety-seven root-filled, crowned teeth with no post and suspected of VRFs were included in the study. Patient details with relevance to endodontic treatment and clinical signs/symptoms were documented, and radiographs were taken. A diagnosis of a VRF was confirmed after surgical flap elevation. Frequency distributions were determined, and statistical analyses were performed using Pearson chi-square analysis, Fisher exact test, cross tabulation, Pearson correlation, and multiple logistic regression. Results: Mandibular molars (34%) and maxillary premolars (22.8%) were the most frequently affected teeth. The postoperative time to the diagnosis of a VRF was 4.35 (+/- 1.96) years. Female patients, posterior teeth, overfilled canals, and patients older than 40 years were associated with the presentation of VRFs within 5 years of the postoperative period. Clinical findings most frequently observed were pain on percussion (60%), pain on palpation (62%), presence of a deep narrow pocket (81%), and sinus tract/swelling (67%). "Halo"-type radiolucency (48.7%) was the most common radiographic feature related to VRFs. Conclusions: Pain on palpation/percussion, deep narrow pocket, sinus tract, and halo-type radio-lucency are characteristic features of VRFs. Posterior teeth, overfilled canals, female patients, and older patients (>40 years) presenting with the previously described clinical features in endodontically treated teeth restored with crowns are more likely to present with VRFs within 5 years postoperatively.