Teeth with vertical root fracture (VRF) have complete or incomplete fractures that begin in the root and extend toward the occlusal surface. The most frequent causes of VRF originate from physical trauma, occlusal prematurity, inadequate endodontic treatment, and iatrogenic causes. Diagnose is difficult and delay can cause stomatognathic system problem. The purpose of this case report was to evaluate immediate implant placement after extraction of teeth with vertical root fracture. For the 1st case, the VRF in 1st left lower molar was confirmed during surgical flap and at the same time, the tooth was removed and immediate implant was placed. For the 2nd case, the VRF 1st left lower molar was confirmed during endodontic access and at the same appointment, the tooth was removed and the immediate implant is placed. Several studies have shown that immediate implants have similar success rates when compared with late implants. Consider that this approach is a safe procedure with favorable prognosis. In cases of VRF, the main factor to be considered is the presence of adequate bone support and immediate implants can preserve the vertical bone height, adding the fact that good patient compliance reduces the number of surgical interventions and promotes the functionality of stomatognathic system. 1. Introduction Vertical root fracture (VRF) according to the American Academy of Endodontics is only located in the root portion dental, directed buccoingual/palatal and is treating the removal of the dental element placement of a fixed or removable prosthesis or a placement implant osseointegrated [1]. A vertical root fracture can present the complete or incomplete form, extending the root portion which may protrude into the enamel to the long axis of the dental element. Usually it extends from the pulp to the periodontal ligament, affecting more often the proximal surfaces. In most cases, a definitive diagnosis of VRF can only be done by periodontal probing, radiographic, and surgical exposure (inspection of the root surface). The most frequent causes of VRF originate from physical trauma, occlusal prematurity, poor endodontic treatment, and dental treatment iatrogenic. The patient often does not have the classic symptoms, masking the diagnosis, which can aggravate the treatment. Maintaining the adjacent bone tissue is important and local bone loss may be related to the time when the patient presents the fracture and local contamination will promote an inflammatory process in the region followed by bone loss. In cases of VRF, the main factor to be considered is the
References
[1]
American Association of Endodontics, Cracking the Cracked Tooth Code: Detection and Treatment of Various Longitudinal Tooth Fractures, American Association of Endodontics, Chicago, Ill, USA, 2008.
[2]
C.-P. Chan, S.-C. Tseng, C.-P. Lin, C.-C. Huang, T.-P. Tsai, and C. C. Chen, “Vertical root fracture in nonendodontically treated teeth—a clinical report of 64 cases in Chinese patients,” Journal of Endodontics, vol. 24, no. 10, pp. 678–681, 1998.
[3]
S. Cohen, L. Blanco, and L. Berman, “Vertical root fractures: clinical and radiographic diagnosis,” Journal of the American Dental Association, vol. 134, no. 4, pp. 434–441, 2003.
[4]
P. Wang and L. Su, “Clinical observation in 2 representative cases of vertical root fracture in nonendodontically treated teeth,” Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology and Endodontology, vol. 107, no. 4, pp. e39–e42, 2009.
[5]
A. Tamse, Z. Fuss, J. Lustig, and J. Kaplavi, “An evaluation of endodontically treated vertically fractured teeth,” Journal of Endodontics, vol. 25, no. 7, pp. 506–508, 1999.
[6]
S. Cohen, L. H. Berman, L. Blanco, L. Bakland, and J. S. Kim, “A demographic analysis of vertical root fractures,” Journal of Endodontics, vol. 32, no. 12, pp. 1160–1163, 2006.
[7]
W. Tang, Y. Wu, and R. J. Smales, “Identifying and reducing risks for potential fractures in endodontically treated teeth,” Journal of Endodontics, vol. 36, no. 4, pp. 609–617, 2010.
[8]
B. Hassan, M. E. Metska, A. R. Ozok, P. van der Stelt, and P. R. Wesselink, “Detection of vertical root fractures in endodontically treated teeth by a cone beam computed tomography scan,” Journal of Endodontics, vol. 35, no. 5, pp. 719–722, 2009.
[9]
S. Y. ？zer, G. ünlü, and Y. De？er, “Diagnosis and treatment of endodontically treated teeth with vertical root fracture: three case reports with two-year follow-up,” Journal of Endodontics, vol. 37, no. 1, pp. 97–102, 2011.
[10]
S. Y. ？zer, “Detection of vertical root fractures of different thicknesses in endodontically enlarged teeth by cone beam computed tomography versus digital radiography,” Journal of Endodontics, vol. 36, no. 7, pp. 1245–1249, 2010.
[11]
I. Tsesis, E. Rosen, A. Tamse, S. Taschieri, and A. Kfir, “Diagnosis of vertical root fractures in endodontically treated teeth based on clinical and radiographic indices: a systematic review,” Journal of Endodontics, vol. 36, no. 9, pp. 1455–1458, 2010.
[12]
S. Schwarz, U. Lohbauer, A. Petschelt, and M. Pelka, “Vertical root fractures in crowned teeth: a report of 32 cases,” Quintessence International, vol. 43, no. 1, pp. 37–43, 2012.
[13]
J. P. Lustig, A. Tamse, and Z. Fuss, “Pattern of bone resorption in vertically fractured, endodontically treated teeth,” Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontics, vol. 90, no. 2, pp. 224–227, 2000.
[14]
G. Pecora, S. Andreana, U. Covani, D. De Leonardis, and R. E. Schifferle, “New directions in surgical endodontics: immediate implantation into an extraction socket,” Journal of Endodontics, vol. 22, no. 3, pp. 135–139, 1996.
[15]
D. W. Siegenthaler, R. E. Jung, C. Holderegger, M. Roos, and C. H. F. H？mmerle, “Replacement of teeth exhibiting periapical pathology by immediate implants. A prospective, controlled clinical trial,” Clinical Oral Implants Research, vol. 18, no. 6, pp. 727–737, 2007.
[16]
N. Casap, C. Zeltser, A. Wexler, E. Tarazi, and R. Zeltser, “Immediate placement of dental implants into debrided infected dentoalveolar sockets,” Journal of Oral and Maxillofacial Surgery, vol. 65, no. 3, pp. 384–392, 2007.
[17]
M. D. M. Naves, B. Z. Horbylon, C. D. F. Gomes, H. H. M. de Menezes, C. Bataglion, and D. de Magalh？es, “Immediate implants placed into infected sockets: a case report with 3-year follow-up,” Brazilian Dental Journal, vol. 20, no. 3, pp. 254–258, 2009.
[18]
M. Del Fabbro, C. Boggian, and S. Taschieri, “Immediate implant placement into fresh extraction sites with chronic periapical pathologic features combined with plasma rich in growth factors: preliminary results of single-cohort study,” Journal of Oral and Maxillofacial Surgery, vol. 67, no. 11, pp. 2476–2484, 2009.
[19]
S. Taschieri, G. Rosano, T. Weinstein, and M. Del Fabbro, “Replacement of vertically root-fractured endodontically treated teeth with immediate implants in conjunction with a synthetic bone cement,” Implant Dentistry, vol. 19, no. 6, pp. 477–486, 2010.
[20]
P. Fugazzotto, “A retrospective analysis of immediately placed implants in 418 sites exhibiting periapical pathology: results and clinical considerations,” The International Journal of Oral & Maxillofacial Implants, vol. 27, no. 1, pp. 194–202, 2012.
[21]
I. Barzilay, “Immediate implants: their current status,” The International Journal of Prosthodontics, vol. 6, no. 2, pp. 169–175, 1993.
[22]
D. Buser, S. T. Chen, H. P. Weber, and U. C. Belser, “Early implant placement following single-tooth extraction in the esthetic zone: biologic rationale and surgical procedures,” International Journal of Periodontics and Restorative Dentistry, vol. 28, no. 5, pp. 441–451, 2008.
[23]
A. Binahmed, A. Stoykewych, and L. Peterson, “Single preoperative dose versus long-term prophylactic antibiotic regimens in dental implant surgery,” The International Journal of Oral & Maxillofacial Implants, vol. 20, no. 1, pp. 115–117, 2005.
[24]
T. J. Lommel, F. Meister, H. Gerstein, E. E. Davies, and M. A. Tilk, “Alveolar bone loss associated with vertical root fractures. Report of six cases,” Oral Surgery, vol. 45, no. 6, pp. 909–919, 1978.
[25]
A. Tamse, I. Kaffe, J. Lustig, Y. Ganor, and Z. Fuss, “Radiographic features of vertically fractured endodontically treated mesial roots of mandibular molars,” Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology and Endodontology, vol. 101, no. 6, pp. 797–802, 2006.
[26]
R. E. Walton, R. J. Michelich, and G. N. Smith, “The histopathogenesis of vertical root fractures,” Journal of Endodontics, vol. 10, no. 2, pp. 48–56, 1984.
[27]
T. Testori, M. Badino, and M. Castagnola, “Vertical root fractures in endodontically treated teeth: a clinical survey of 36 cases,” Journal of Endodontics, vol. 19, no. 2, pp. 87–91, 1993.
[28]
H. Salama and M. Salama, “The role of orthodontic extrusive remodeling in the enhancement of soft and hard tissue profiles prior to implant placement: a systematic approach to the management of extraction site defects,” The International Journal of Periodontics & Restorative Dentistry, vol. 13, no. 4, pp. 312–333, 1993.
[29]
C. Tinti and S. Parma-Benfenati, “Clinical classification of bone defects concerning the placement of dental implants,” International Journal of Periodontics and Restorative Dentistry, vol. 23, no. 2, pp. 147–155, 2003.
