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 Table of Contents  
CASE REPORT
Year : 2014  |  Volume : 2  |  Issue : 3  |  Page : 154-156

Diagnosis of mandibular premolar tooth with vertical root fracture using by cone-beam computed tomography


1 Department of Endodontics, Faculty of Dentistry, Ataturk University, Erzurum, Turkey
2 Departments of Oral and Maxillofacial Radiology, Faculty of Dentistry, Izmir Katip Celebi University, Izmir, Turkey
3 Departments of Histology and Embryology, Faculty of Medicine, Izmir Katip Celebi University, Izmir, Turkey

Date of Web Publication29-Oct-2014

Correspondence Address:
Ezgi Doganay
Department of Endodontics, Faculty of Dentistry, Atatürk University, Erzurum - 25640
Turkey
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2321-4619.143600

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  Abstract 

Vertical root fracture (VRF) may occur because of root canal treatment or extensive restoration. A 42-year-old woman applied to our clinic with complaint of pain on her left mandibular second premolar tooth. Radiologic examination by panoramic radiograph indicated that the teeth had a root canal treatment and there was a radiolucency through the mesial area of the root. This data was considered that there might be a root fracture, which cannot be detected on panoramic radiograph. Thus, the condition was told to the patient and after her permission, it was decided to take a CBCT image for definite diagnosis. The tooth was scheduled for extraction and socket preservation. A new CBCT image was taken from the extracted teeth with much more dosage to observe the fracture line every aspect. Also, the tooth was sent to the histology department for histologic investigation. The CBCT image demonstrated hardly visible VRF at the coronal, mid-root and apical levels in the axial views. Fracture line that extends through the long axis of the tooth was seen obviously on CBCT image which was taken after extraction and histologically with different zoom in (×25, ×40, ×100, ×200, and ×400). Different stages of endodontic treatment may cause VRFs. Symptoms of VRF are often not obvious, because of this diagnosis may be difficult for dentists. CBCT images could be helpful to evaluate VRFs which cannot diagnose.

Keywords: Cone-beam computed tomography, diagnosis, vertical root fracture


How to cite this article:
Doganay E, Arslan H, Ertas ET, Simsek F. Diagnosis of mandibular premolar tooth with vertical root fracture using by cone-beam computed tomography . J Res Dent 2014;2:154-6

How to cite this URL:
Doganay E, Arslan H, Ertas ET, Simsek F. Diagnosis of mandibular premolar tooth with vertical root fracture using by cone-beam computed tomography . J Res Dent [serial online] 2014 [cited 2019 Dec 13];2:154-6. Available from: http://www.jresdent.org/text.asp?2014/2/3/154/143600


  Introduction Top


Vertical root fracture (VRF) may occur because of root canal treatment or extensive restoration. Than 61.7% of the reason for VRFs is a post in root canal. Of all fractured roots, fracture lines in 67.5% were in the buccolingual direction, and 32.5% were in the mesiodistal direction. [1] Diagnosis and treatment of VRFs might be hard for clinicians. Definitive diagnosis is usually difficult because of the lack of consistent symptoms and the low sensitivity of conventional radiographs in the determination of VRFs. [2] Using by some various radiography techniques; fracture line should be investigated and should be detected the distance between fragments. In this sense periapical and panoramic radiographs, and cone-beam computed tomography (CBCT), which can show image of three-dimensional (3D) representation of the bone and tooth structures unlike others, are used. Three-dimensional images are found to be more successful than two-dimensional (2D) radiographic techniques in recognize root fractures. [3]

Decision of the appropriate treatment might be perplexing for the dentist, and it often ends up extraction, root amputation, and implant/denture insertion to prevent more bone loss and periodontal destruction. [2] If it is necessary to extract the tooth, clinician must determine whether surgery will be planned with simultaneous flap operation or with normal extraction without flap reflection. [4]


  Case report Top


A 42-year-old woman applied to the clinic with a complaint of pain on her left mandibular second premolar tooth. She didn't have a systemic disease. The extra-oral examination did not reveal any pathologic sign. Intra-oral examination revealed that mandibular second premolar tooth had a crown and was tender to percussion and palpation. There was no evidence of swelling or fistula.

Radiologic examination by panoramic radiograph indicated that the teeth had a root canal treatment and there was radiolucency through the mesial area of the root [Figure 1]. This data was considered that there might be a root fracture, which cannot be detected on panoramic radiograph. Thus, it was decided to take a CBCT image. After the patient was informed and signed an informed consent form, the CBCT images were obtained with a NewTom 5G CBCT machine (NewTom 5G(®), QR, Verona, Italy). The CBCT image demonstrated hardly visible vertical root fracture at the coronal, mid-root and apical levels in the axial views [Figure 2].
Figure 1: Panoramic radiographs shows halo appearance

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Figure 2: CBCT taken before the extraction shows hardly visible fracture lines

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The patient was instructed about the treatment alternatives, however, the patient did not accept the treatment and decided to her tooth to be extracted. Therefore the patient was scheduled for extraction and socket preservation.

A CBCT image was taken from the extracted teeth with much more dosage to observe the fracture line in every aspect [Figure 3]. Then, sections were also cut for histologic investigation. Sections were stained using by convenient dye. Fracture line that extends through the long axis of the tooth was seen histologically with different zoom in (×25, ×40, ×100, ×200, and × 400) [Figure 4].
Figure 3: CBCT taken after the extraction with high resolution shows obvious fracture lines

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Figure 4: Histologic examination on the sections confirmed the fracture line

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  Discussion Top


This case report highlights the diagnostic challenge of the VRF. Normally, VRF could be diagnosed by clinical and radiographic examination. The symptoms such as pain, swelling, and sinus tract could be sign for the VRF. Radiographically, the halo appearance radiolucency could be indicating VRF. However, the definitive diagnosis of the VRF represents a challenge for the clinician and can be made only direct visual examination.

In the present case report, the VRF could not be detected by using two-dimensional radiographic techniques, but was detected by CBCT. In previous reports, CBCT was found to be beneficial for detection of VRFs. [5],[6] This case report confirms the previous reports.


  Conclusion Top


In conclusion, different stages of endodontic treatment may cause VRFs. Symptoms are often not obvious, because of this diagnosis may be difficult for dentists. Some radiologic methods are needed. In this term, CBCT could be beneficial to determine if there is a no detectable fracture line by using 2D radiographic techniques.



 
  References Top

1.
Hassan B, Metska ME, Ozok AR, van der Stelt P, Wesselink PR. Detection of vertical root fractures in endodontically treated teeth by a cone beam computed tomography scan. J Endod 2009;35:719-22.  Back to cited text no. 1
    
2.
Tseis I, Rosen E, Tamse A, Taschieri S, Kfir A. Diagnosis of vertical root fractures in endodontically treated teeth based on clinical and radiographic indices; asystematic review. J Endod 2010;36:1455-8.  Back to cited text no. 2
    
3.
Mora MA, Mol A, Tyndall DA, Rivera EM, Hill C. In vitro assessment of local computed tomography for the detection of longitudinal tooth fractures. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2007;103:825-9.  Back to cited text no. 3
    
4.
Öztürk M, Ünal GÇ. A successful teatment of vertical root fracture: A case report and 4-year follow-up. Dent Traumatol 2008;24:e56-60.  Back to cited text no. 4
    
5.
Tsesis I, Kamburoglu K, Katz A, Tamse A, Kaffe I, Kfir A. Comparison of digital with conventional radiography in detection of vertical root fractures in endodontically treated maxillary premolars: An ex vivo study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2008;106:124-8.  Back to cited text no. 5
    
6.
Melo SL, Bortoluzzi EA, Abreu M, Correa LR, Correa M. Diagnostic ability of a cone- beam computed tomography scan to assess longitudinal root fractures in prosthet- ically treated teeth. J Endod 2010;36:1879-82.  Back to cited text no. 6
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

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