A new surgical technique for preservation of endodontically treated teeth with coronally located vertical root fractures: a prospective case series Silvio Taschieri, MD, DDS, a Aviad Tamse, DMD, b Massimo Del Fabbro, BSc, PhD, c Gabriele Rosano, DDS, d and Igor Tsesis, DMD, e Milan, Italy; and Tel Aviv, Israel UNIVERSITY OF MILAN AND TEL AVIV UNIVERSITY Objective. The purpose of this study was to present a new surgical preservation technique for teeth with incomplete vertical root fracture. Study design. Seventeen patients with 1 endodontically treated maxillary anterior tooth in which an incomplete vertical root fracture involving only the buccal side was suspected underwent a flap elevation procedure to visualize the pattern of bone loss and assess the type of root fracture. If the preoperative diagnosis was confirmed, a groove following the fracture line was prepared using retro-tips driven by an ultrasonic device and sealed with mineral trioxide aggregate after filling of the bone defect with calcium sulfate. Results. A total of 10 vertical root fracture repair procedures were performed. At 12 months’ follow-up, all cases showed clinical and radiographic success. After 33 months, 7 patients were available for a follow-up: 5 cases remained successful, and 2 teeth (lateral incisors) failed. Conclusions. The present surgical approach for preservation of teeth with incomplete vertical root fracture demonstrated satisfactory results regarding clinical outcome. (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2010;110:e45-e52) Vertical root fracture (VRF) is one of the most frustrating complications of root canal therapy and results in tooth or root extraction. 1,2 Depending on the nature of the causing agents, VRF may originate either from the apical end of the root and propagate coronally or from the cervical portion of the root, extending in an apical direction. 1 VRF often expands laterally from the root canal wall to the root surface. An incomplete fracture involves only 1 side of the root, while a complete fracture expands in opposite directions of the root canal involving 2 root surface aspects. 1,3,4 A definitive diagnosis of VRF in endodontically treated teeth is at times complicated. 5,6 Clinical signs and symptoms associated with VRF as well as radiographic presentation are often similar to those associated with unsuccessful endodontic treatment and with certain forms of periodontal dis- ease. 2,3,7-9 Nevertheless, a rapid decision is neces- sary to avoid excessive bone loss, which can impair reconstructive procedures should implant therapy be the treatment of choice. 1 In doubtful cases, a defin- itive diagnosis of VRF is best attained by invasive diagnostic procedures, such as an exploratory surgi- cal flap. 7,10,11 Prognosis of VRF most often is hopeless. Attempts to treat VRF by using extraction, bonding of fractured segments, and replantation have been reported, 12-14 but such treatment is unpredictable and cannot be recom- mended. Selden 15 reported conservative treatment of 6 teeth with incomplete VRF by using silver glass-iono- mer cement with bone graft, but all of the cases pre- sented in that study failed in the long term. 15 In recent years, new endodontic materials and techniques have been developed, improving the clinician’s ability to treat the teeth which previously had been doomed to extraction. 16-18 Magnification devices that have been introduced in endodontics help to improve diagnostic capability and increase the accuracy of the endodontic procedure, owing to a better visualization of the treat- ment field. 17,19 a Head, Department of Odontology, Istituto Ortopedico Galeazzi, Is- tituto Di Ricovero e Cura a Carattere Scientifico, University of Milan. b Professor, Department of Endodontology, Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv University. c Researcher and Head of Oral Physiology, Istituto Ortopedico Galea- zzi, Istituto Di Ricovero e Cura a Carattere Scientifico, University of Milan. d PhD student, Section of Endodontics, Istituto Ortopedico Galeazzi, Istituto Di Ricovero e Cura a Carattere Scientifico, University of Milan. e Coordinator of Graduate Endodontics, Department of Endodontol- ogy, Tel Aviv University, Israel. Received for publication Mar 31, 2010; returned for revision Jun 26, 2010; accepted for publication Jul 20, 2010. 1079-2104/$ - see front matter © 2010 Mosby, Inc. All rights reserved. doi:10.1016/j.tripleo.2010.07.014 e45