Abstract
The etiology of vertical root fractures (VRFs) in endodontically treated teeth is complex because of its multifactorial nature. Since there is no single specific etiology that is pathognomonic for this complication that can be identified, prevention of vertical root fractures in endodontically treated teeth is quite difficult. There are predisposing factors as well as contributing ones. The predisposing factors are practically noncontrollable. These include the specific anatomy of the susceptible roots, biochemical changes in the root dentin in the endodontically treated tooth, and loss of healthy tooth substance as a result of caries and trauma before beginning endodontic procedures. The contributing factors are attributed to the iatrogenic risk factors associated with various dental procedures performed on the tooth. These clinical etiologies will be discussed in the first section, and a fracture mechanics perspective will be presented in the second section. This will incorporate geometry, material, and loading issues when a dentinal crack is initiated in the canal wall, which is a precursor for a future complete and incomplete fracture in the root at a later stage.
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References
Chan CP, Lin CP, Tseng SC, Jeng JH. Vertical root fracture in endodontically versus non-endodontically treated teeth. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1999;87(4):504–7.
Tamse A. Vertical root fractures in endodontically treated teeth: diagnostic signs and clinical management. Endod Top. 2006;13:84–94.
Tang W, Wu Y, Smales RJ. Identifying and reducing risks factors in emdodontically treated teeth. J Endod. 2010;36:609–17.
Tamse A. Vertical root fractures in endodontically treated teeth. In: Ingle JI, Bakland LK, Baumgartner JC, editors. Ingle’s endodontics. 6th ed. Hamilton: BC Decker, Inc; 2008. p. 676–89.
Kishen A, Kumar GV, Chen NN. Stress-strain response in human dentine; rethinking fracture predilection in post core restored teeth. Dent Traumatol. 2004;20:90–100.
Sornkule E, Stannard JG. Strength of roots before and after endodontic treatment and restorations. J Endod. 1992;18:440–3.
Gutmann JL. The dentin-root complex: anatomic and biologic considerations in restoring endodontically treated teeth. J Prosthet Dent. 1992;67:458–67.
Tamse A, Fuss Z, Lustig J, Kaplavi J. An evaluation of endodontically treated vertically fractured teeth. J Endod. 1999;25:506–8.
Tamse A, Katz A, Pilo R. Furcation groove of the buccal root of maxillary first premolars – a morphometric study. J Endod. 2000;6:359–63.
Katz A, Wasenstein-Kohn S, Tamse A, Zuckerman O. Residual dentin thickness in bifurcated maxillary premolars after root canal and dowel space preparation. J Endod. 2006;32:202–5.
Li J, Li L, Pan Y. Anatomic study of the buccal root with furcation groove and associated root canal shape in maxillary first premolars by using micro-computed tomography. J Endod. 2013;39:265–8.
Pilo R, Shapenco E, Lewinstein I. Residual dentin thickness in bifurcated maxillary first premolars after root canal and post space preparation with parallel-sided drills. J Prosthet Dent. 2008;99:267–73.
Lertchirakarn V, Palamara J, Messer HH. Patterns of vertical fractures: factors affecting stress distribution in the root canal. J Endod. 2003;29:523–8.
Russel AA, Hong L, Chandler NP. Investigation of dentin hardness in roots exhibiting the butterfly effect. J Endod. 2014;40:842–4.
Pilo R, Corcino G, Tamse A. Residual dentin thickness in mandibular premolars prepared by hand and rotatory instruments. J Endod. 1998;24:401–5.
Trabert KC, Caputo AA, Abou-Rass M. Tooth fracture. A comparison of endodontic and restorative treatments. J Endod. 1978;4:341–5.
Çobankara FK, Üngör M, Belli S. The effect of two different root canal sealers and smear layer on resistance to root fracture. J Endod. 2002;28:606–9.
Rundquist BD, Versluis A. How does canal taper affect root stress? Int Endod J. 2006;39:226–37.
Helfer AR, Melnick S, Schilder H. Determination of the moisture content of vital and pulpless teeth. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1972;34:661–70.
Rivera EM, Yamauchi M. Site comparisons of dentine collagen cross-links from extracted human teeth. Arch Oral Biol. 1993;38:541–6.
Stanford JW, Weigal KU, Paffenbarger GC, Sweeney WT. Compressive properties of hard tooth tissue. J Am Dent Assoc. 1960;60:746–56.
Huang JG, Schilder H, Nathanson D. Effects of moisture content and endodontic treatment of some mechanical properties of human dentin. J Endod. 1992;18:209–2015.
Wollard RR, Brough SO, Maggio I, Seltzer S. Scanning electron microscopic examination of root canal filling materials. J Endod. 1976;2:98–110.
Boyarsky H, Davis R. Root fracture with dentin retained post. Am J Dent. 1992;5:11–4.
Onnink PA, Davis RD, Wayman BE. An in vitro comparison of incomplete root fractures associated with obturation technique. J Endod. 1994;20:32–7.
Reinhardt RA, Krejci RF, Pao YC, Stannard JG. Dentin stress in posts reconstructed with diminishing bone support. J Dent Res. 1983;62:1002–8.
Reeh ES, Messer HH, Douglas WH. Reduction in tooth stiffness as a result of endodontic and restorative procedures. J Endod. 1989;15:512–6.
Fuss Z, Lustig J, Katz A, Tamse A. An evaluation of endodontically treated vertically fractured roots: impact of operative procedures. J Endod. 2001;27(1):46–8.
Holcomb JA, Pitts DL, Nickolls JI. Further investigation of spreader loads required to cause vertical root fracture during lateral condensation. J Endod. 1987;13:277–84.
Saw L-H, Messer HH. Root strains associated with different obturation techniques. J Endod. 1995;21:314–20.
Lertchirakarn V, Palamara JE, Masser HH. Load and strain during lateral condensation and vertical root fracture. J Endod. 1999;25:99–104.
Zandbiglari T, Davids H, Schafer E. Influence of instrument taper on the resistance to fracture of endodontically treated roots. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2006;101:126–31.
Liu RL, Hou BX, Wesselink PR, Wu MK, Shemesh H. The incidence of root microckracks caused by 3 different single-file systems versus the ProTaper System. J Endod. 2013;39:1054–6.
Bier CAS, Shemesh H, Tanomaru-Filbo M, Wesselink PW, Wu MK. The ability of different Nickel-Tiyanium rotary instruments to induce dentinal damage during canal preparation. J Endod. 2009;35:236–8.
Kim HC, Lee MH, Yum J, Versluis A, Lee CJ, Kim BM. Potential relationship between design of Nickel-Tiyaniu, rotary instruments and vertical root fracture. J Endod. 2010;36:1195–9.
Rass M. Crack lines: the precursors of tooth fratures – their diagnosis and treatment. Quintessence Intl Dent Dig. 1983;14(4):437–47.
Del Fabbro M, Tsesis I, Rosano G, Bortolin M, Taschieri S. Scanning electron microscopic analysis of the integrity of the root –end surface after root-end management using a piezoelectric device: a cadaveric study. J Endod. 2010;36:1693–7.
Qian W, Shen Y, Haapasalo M. Qantitative analysis of the effect of irritant solutions sequences on dentin erosion. J Endod. 2011;37:1437–41.
Gasic J, Popovic J, Zivkovic S, Petrovic A, Barac R, Nikolic M. Ultrastructural analysis of root canal walls after simultaneous irrigation of different sodium Hypochlorite concentrations and 0.2 % chlorhexidine gluconate. Microsc Res Tech. 2012;75:1099–103.
Morando G, Leupold RJ, Reiers JC. Measurements of hydrostatic pressure during simulated post cementation. J Prosthet Dent. 1995;74:586–90.
Cheung W. A review of the management of endodontically treated teeth. J Am Dent Assoc. 2005;136:611–9.
Endodontics: Colleagues for Excellence. Restoration of endodontically treated teeth. Chicago: American Association of Endodontists; 2004.
Cagidiaco MC, Garcia-Godoy F, Vichi A, Grandini S, Goracci C, Ferrari M. Placement of fiber prefabricated or custom made posts affects the 3 year survival of endodontically treated premolars. Am J Dent. 2008;21:179–84.
Salameh Z, Sorrentino R, Ounsi HF, Goracci C, Tashkandi E, Tay FR, Ferrari M. Effect of all ceramic crown system on fracture resistance and failure pattern of endodontically treated maxillary premolars restored with and without glass fiber posts. J Endod. 2007;33:848–51.
Salameh Z, Sorrentino R, Ounsi HF, Sadig W, Atiyeh F, Ferrari M. The effect of different full coverage crown systems on fracture resistance and failure pattern of endodontically treated maxillary incisors restored with and without glass fiber posts. J Endod. 2008;34:842–6.
Ferrari M, Vicci A, Fadda GM, Cagidiaco MC, Tay FR, Breschi L, Polimeni A, Goracci C. A randomized controlled trial of endodontically treated and restored premolars. J Dent Res. 2012;71:72S–8.
Al-Omiri MK, Mahmoud AA, Rayyan MR, Abou-Hammad O. Fracture resisance of teeth with post retained restorations: an overview. J Endod. 2010;36:1439–49.
Meister F, Lommel TJ, Gerstein H. Diagnosis and possible causes of vertical root fractures. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1980;49:243–53.
Cailleteau JG, Rieger MR, Akin JE. A comparison of intracanal stresses in a post-restored tooth utilizing the finite element method. J Endod. 1992;18:540–4.
Ricks-Williamson LJ, Fotos PG, Goel VK, Spivey JD, Rivera EM, Khera SC. A three-dimensional finite-element stress analysis of an endodontically prepared maxillary central incisor. J Endod. 1995;21:362–7.
Yaman SD, Alacam T, Yaman Y. Analysis of stress distribution in a vertically condensed maxillary central incisor root canal. J Endod. 1995;21:321–5.
Telli C, Gülkan P, Raab W. Additional studies on the distribution of stresses during vertical compaction of gutta-percha in the root canal. Br Dent J. 1999;187:32–7.
Lertchirakarn V, Palamara JEA, Messer HH. Finite element analysis and strain gauge studies of vertical root fracture. J Endod. 2003;29:529–34.
Sathorn C, Palamara JEA, Messer HH, Palamara D. Effect of root canal size and external root surface morphology on fracture susceptibility and pattern: a finite element analysis. J Endod. 2005;31:288–92.
Sathorn C, Palamara JEA, Messer HH. A comparison of the effects of two canal preparation techniques on root fracture susceptibility and fracture pattern. J Endod. 2005;31:283–7.
Versluis A, Messer HH, Pintado MR. Changes in compaction stress distributions in roots resulting from canal preparation. Int Endod J. 2006;39:931–9.
Chai H, Tamse A. Fracture mechanics analysis of vertical root fracture from condensation of gutta-percha. J Biomech. 2012;45:1673–82.
Lam PPS, Palamara JEA, Messer H. Fracture strength of tooth roots following canal preparation by hand and rotary instrumentation. J Endod. 2005;31:529–32.
Hammad M, Qualtrough A, Silikas N. Effect of new obturating materials on vertical root fracture resistance of endodontically treated teeth. J Endod. 2007;33:732–6.
Hegde MN, Shetty S, Godara N. “Evaluation of fracture strength of tooth roots following canal preparation by hand and rotary instrumentation” – an invitro study. Endodontology. 2008;20:22–9.
Pitts DL, Matheny HE, Nicholls JI. An in vitro study of spreader loads required to cause vertical root fracture during lateral condensation. J Endod. 1983;9:544–50.
Soros C, Zinelis S, Lambrianidis T, Palaghias G. Spreader load required for vertical root fracture during lateral compaction ex vivo: evaluation of periodontal simulation and fracture load information. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2008;106:e64–70.
Savin GN. Stress concentration around holes. New York: Pergamon press; 1961.
Harvey TE, White JT, Leeb IJ. Lateral condensation stress in root canals. J Endod. 1981;7:151–5.
Shemesh H, Bier CAS, Wu M-K, Tanomaru-Filho M, Wesselink PR. The effects of canal preparation and filling on the incidence of dentinal defects. Int Endod J. 2009;42:208–13.
Adorno CG, Yoshioka T, Jindan P, Kobayashi C, Suda H. The effect of endodontic procedures on apical crack initiation and propagation ex vivo. Int Endod J. 2013;46:763–8.
Koester KJ, Ager III JW, Ritchie RO. The effect of aging on crack-growth resistance and toughening mechanisms in human dentin. Biomaterials. 2008;29:1318–28.
Nazari A, Bajaj D, Zhang D, Romberg E, Arola D. Aging and the reduction in fracture toughness of human dentin. J Mech Behav Biomed Mater. 2009;2:550–9.
Cohen S, Berman LH, Blanco L, Bakland L, Kim JS. Demographic analysis of vertical root fractures. J Endod. 2006;32:1160–3.
Sugaya T, Nakatsuka M, Inoue K, Tanaka S, Miyaji H, Sakagami R, Kawamami M. Comparison of fracture sites and post lengths in longitudinal root fractures. J Endod. 2015;41:159–63.
Walton RE, Michelich RJ, Smith GN. The histopathogenesis of vertical root fractures. J Endod. 1984;10:48–56.
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Tamse, A., Chai, H. (2015). Etiology of Vertical Root Fractures. In: Tamse, A., Tsesis, I., Rosen, E. (eds) Vertical Root Fractures in Dentistry. Springer, Cham. https://doi.org/10.1007/978-3-319-16847-0_3
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DOI: https://doi.org/10.1007/978-3-319-16847-0_3
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