The diagnosis of a vertical root fracture(VRF)is challenging in the absence of pathognomonic signs. The presence of a large restoration and intra-canal post, multiple sinus tracts, narrow deep pocket alongside the root, periodontal abscess, mobility, and lateral radiolucency all could be considered signs of a VRF. However, not all these signs are always present to comfortably diagnose a fracture. Having said that, the definite diagnosis of a VRF will still stay with direct visual examination and visualizing the fracture line, which is not always feasible.
The question is if dental CT scan can help in the diagnosis of a VRF. The answer is yes and no. If yes, it does not mean a fracture line should be seen on the CT scan to diagnose a fracture. On the contrary, other signs should be explored on the CT scan rather than looking for a fracture line. For instance, like the case presented below, the buccal bone is detached from the buccal aspect of the root in fracture cases. However, this sign could still be due to a long-lasting infection and drainage. As you see, the diagnosis of a VRF is still challenging even with the use of CT scan. A combination of clinical examination, radiography, CT scan, and experience should go hand in hand to diagnose a root fracture.
Case presentation:
A 60-year old man with type II diabetes was examined for fracture in 3.7. He was a grinder. The clinical exam showed a swelling over the buccal aspect of mesial root like a periodontal abscess. Both percussion and palpation were positive. Mobility was +2. Periodontal probing demonstrated a 10-mm pocket at the buccal edge of mesial root. Radiography revealed previous root canal treatment and a rarefying osteitis at the mesial root apex. On the CT, buccal bone has detached from the buccal aspect of mesial root (yellow arrow), consistent with the 10-mm pocket. A diagnosis of a vertical root fracture in the mesial root was made. Despite that emergence of a fracture line was not expected, it was visible (red arrow).
Conclusion: The reason to order a dental CT scan to diagnose a VRF is not to see the fracture line. The pattern of bone loss is the main indicative of a VRF.
