Vertical root fractures: A scoping review

Abstract

Vertical root fractures (VRFs) represent a complex clinical challenge predominantly affecting endodontically treated posterior teeth, often leading to tooth loss. This review explores the etiology, clinical presentation, risk factors, radiographic characteristics, and management of VRFs. Structural compromise due to loss of residual dentine, presence of pre-existing cracks, altered biomechanical properties following endodontic procedures, and systemic factors such as diabetes mellitus significantly increase susceptibility to VRF. Diagnosis remains challenging due to subtle or non-specific clinical and radiographic signs, although cone-beam computed tomography (CBCT) may enhance detection through identification of periradicular bone loss. Management is often limited to extraction, though root resection procedures may offer tooth preservation in select cases. Early diagnosis and preventive strategies during endodontic and restorative treatments are vital for reducing the incidence of VRFs and improving long-term tooth survival.