Exploratory surgery to determine cause of failure

Over time and repeated dental treatments, teeth become mechanically weaker. This can create cracks and fractures at the roots (below the gum level).

Vertical root fractures  are considered to be a severe complication, with a hardly conclusive and often confusing diagnosis, which unavoidably leads to tooth extraction. The differential diagnosis between a vertical root fracture  and failed endodontic treatment or periodontal disease requires an analysis of complementary examinations in addition to the clinical data and the history of the affected tooth. Among these, the most used is the periapical radiographic examination. Notwithstanding, vertical root fractures are rarely observed in this examination because the central X-ray beam does not fall on the fracture plane. A vertical root fracture is only observed on a periapical radiograph if the root fragments are separated. However, some characteristics of the radiographic image may suggest a vertical root fracture, such as radiopaque signs due to sealer overflow at the external root surface, isolated horizontal bone loss, unexplained bone loss at the furcation region, diffuse V-shaped bone loss, enlargement of the periodontal ligament space and a radiolucent "halo" around the entire root surface.

Τhe definite diagnosis of a vertical root fracture is only conclusive when the affected tooth is surgically explored to visualise the fracture line.