The diagnostic challenge of vertical root fracture in endodontically treated teeth: a case report

Vertical root fractures (VRFs) may affect any human tooth, either vital or non-vital. Teeth that morphologically present roots with mesiodistal flattening and undergo endodontic therapy are considered the most susceptible to a VRF occurrence. The prevalence of VRFs is 52% in maxillary and mandibular premolars, followed by the mesial roots of mandibular molars (24%), maxillary and mandibular central and lateral incisors (14%) and the mesiobuccal and palatal roots of the maxillary molars (10%) A VRF in endodontically treated teeth may be defined as a line in the longitudinal direction, initiating at the internal root canal wall and extending to the external root surface toward the periodontal tissues. It occurs in any third of the root canal and tends to split the root in the buccolingual direction. 

The characteristic signs and symptoms may manifest in days or years after the fracture: sensitivity to vertical percussion (VP) and digital palpation (DP), the presence of a fistula and a deep and isolated periodontal pocket. Radiographically, periapical and lateral radiolucency is present with a "halo" shape in the supposedly affected tooth.