Clinical Oral Investigations

, Volume 18, Issue 8, pp 2015–2021 | Cite as

Comparative assessment of the incidence of vertical root fractures between conventional versus surgical endodontic retreatment

  • L. Karygianni
  • M. Krengel
  • M. Winter
  • S. Stampf
  • K. T. WrbasEmail author
Original Article



Vertical root fractures (VRFs) are a common cause of tooth loss. Little evidence exists though, relating the incidence of VRFs to the type of endodontic retreatment. This retrospective study aimed at evaluating the impact of conventional versus surgical endodontics on root canal-filled teeth with VRFs.

Materials and methods

Over a period of 13 years, 200 endodontically retreated teeth from 192 patients with VRFs were extracted and further examined. VRFs were assessed in relation to age, gender, tooth group, clinical signs, extension on the root surface, patency, as well as type of endodontic retreatment and restoration. Statistical analysis was conducted using a Cox PH Model, Chi-squared, Wilcoxon rank-sum, and Log rank tests at a significance level of 5 %.


The majority of teeth with VRFs (62.31 %) had undergone the combination of conventional root canal retreatment and apical surgery. Women (64.06 %) presented VRFs more frequently than men (35.94 %) at the mean age of 51.1 and 55.1 years, respectively. Maxillary first (17.5 %) and second (16.5 %) premolars, restored by a resin-based material without a post (56.28 %) were more susceptible to VRFs. Apically initiated (84.1 %) VRFs could be diagnosed more easily on radiographs.


The type of endodontic treatment strongly correlated with VRFs. The prevalence of VRFs in teeth having undergone both conventional and surgical endodontic retreatment could be attributed, among others, to additive dentin damage related to the aforementioned endodontic procedures.

Clinical relevance

The possible involvement of endodontic retreatment in the multifactorial etiology of VRFs needs to be taken into consideration in clinical practice.


Apical surgery Clinical signs Endodontic retreatment Vertical root fractures 



The authors express their gratitude to Dr. Fadil Elamin, Jonathan Bass, and Dr. Dougal Laird for their valuable scientific and linguistic contribution to this report.

Conflict of interest

We declare that this manuscript is original, has not been published before and is not currently being considered for publication elsewhere. We wish to confirm that there are no known conflicts of interest associated with this publication and there has been no significant financial support for this work that could have influenced its outcome. The manuscript has been read and approved by all named authors.


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Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • L. Karygianni
    • 1
  • M. Krengel
    • 2
  • M. Winter
    • 3
  • S. Stampf
    • 4
  • K. T. Wrbas
    • 1
    • 5
    Email author
  1. 1.Department of Operative Dentistry and Periodontology, Center for Dental Medicine, Medical Center University of FreiburgFreiburgGermany
  2. 2.Bergisch GladbachGermany
  3. 3.RheinbachGermany
  4. 4.Institute of Medical Biometry and Medical InformaticsAlbert-Ludwigs-UniversityFreiburgGermany
  5. 5.Department of Endodontics, Centre for Operative Dentistry and PeriodontologyUniversity of Dental Medicine and Oral Health, Danube Private University (DPU)KremsAustria

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