30 January 2023

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Vertical fracture of the root

Massimo Gagliani

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Some good friends say they always read me, some make fun of my puns and many others read and keep their thoughts to themselves. Every now and then someone pops up with questions that often betray the amazement of those who measure themselves with different realities. That was the case for the theme of vertical fractures.

I say this in the preamble phase: vertical fracture of the root equal to extraction of the tooth involved. I don't say it authoritatively but with the support of ultimate scientific evidence and consolidated clinical practice.

A recent literature search reveals exceptional cases in which situations of vertical root fractures are solved with the most extraordinary concoctions. In this regard I also saw a Japanese dentist who, in the mists of time, tied the two fragments with orthodontic metal ligatures. And they worked.

More recent articles are struggling to find means, the Cone Beam CT above all, to diagnose this unfortunate clinical eventuality in advance. It is such because, as well demonstrated by various researchers, the development of particularly aggressive bacterial species leads to a massive destruction of bone tissue. To be restored, this often involves the use of anything but simple regenerative methods. Personally, I had the opportunity with my friend and colleague Professor Marcello Maddalone of the University of Milan Bicocca to verify how many cases were sent with a request for endodontic surgery, which later turned out to be vertical fractures of the root, some of which started apically. Not a negligible number.

It is therefore no coincidence that experiments in this area can be of various kinds but, beyond their extemporary nature, the resolution of these cases is limited to hypotheses rather than consolidated certainties.