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

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.