Frank Meister

Diagnosis and possible causes of vertical root fractures

Thirty-two cases of vertical fractures were studied in an attempt to identify the causes and diagnostic signs normally present. In all of the patients except two, osseous defects were present and could be probed. The majortiy (65.63 percent) had only mild pain or a dull discomfort. Seventy-five percent showed diffuse widening of the periodontal ligament space. This study suggests that excessive force during lateral condensation of the gutta-percha caused 84.38 percent of the fractures. A secondary cause was the forcing or tapping of inlays or dowels into place. The majority (78.13 percent) of the patients were over the age of 40. In all but nine of the cases, treatment consisted of the extraction of the involved teeth.

Alveolar bone loss associated with vertical root fractures: Report of six cases

Six cases of vertical root fractures accompanied by vertical bone loss are presented. Possible causes for these fractures are suggested. Four vertical fractures probably resulted from the use of excessive pressure at the time of obturation of the canals. One vertical root fracture may have been caused by the cementation of a post, and another may have been caused by the cementation of an inlay in an endodontically treated tooth. All of the fractures resulted in alveolar bone loss to the apical extent of the fracture lines. The definitive treatment in each case was extraction of the tooth or root amputation. In one case successful treatment was accomplished by apically positioning the flap.

Endodontic perforations which resulted in alveolar bone loss. Report of five cases.

Five cases in which perforations of mandibular molars into the furca occurred during endodontic instrumentation of the canal are presented. This resulted in alveolar bone loss. All were relatively asymptomatic, which could present a problem in diagnosis of the periodontal defect. The prognosis is questionable. The only tooth retained was treated surgically by an apically positioned flap and opening of the furca area to make it accessible to cleansing. The best treatment is the avoidance of the perforation. This is accomplished by considering the configuration of the canals and the size of the reamer than can follow it. Overinstrumentation with an endodontic instrument that is too large in diameter should be avoided.

Successful treatment of a radicular lingual groove: case report.

The vertical developmental radicular groove canlead to an untreatable periodontal condition. It is probable that there may be a gamut of defects ranging from a groove running from the cingulum apically along the root for varying distances to a complete lack of closure of the calcified tissues, allowing for a direct soft tissue connection between the pulp and the periodontium. Usually extraction of the involved tooth is the treatment of choice. In this case combined endodontic-periodontic therapy was successful in retaining the tooth in a relatively healthy state.

An additional clinical observation in two cases of vertical root fracture

Abstract Cases involving vertical root fractures in endodontically treated teeth can present difficulties in diagnosis. There are clinical and radiographic signs that, when present, can make diagnosis easier. In the two cases presented here, displacement of portions of the root occurred long after obturation of the canal. This spreading apart or movement of the apical portions of the root could be a result of pressure from the proliferating chronic granulation tissue that was present. The radiographic finding of displacement of apical portions of the root can be an additional diagnostic sign that a vertical root fracture had occurred.

Treatment of external resorption by a combined endodontic-periodontic procedure

A case of external resorption of a mandibular first premolar where both endodontic therapy and periodontal surgery were needed is presented. The patient came to the Dental School with a complaint of pain in the mandibular right quadrant. Radiographically, an irregular radiolucency was present at the cemental enamel junction. The essential biological principles for this treatment to be successful are given.

Use of a pedicle flap to correct an endodontic problem: a case report

A maxillary left central incisor had a root that was chronically exposed to the oral environment. Two different surgical procedures were performed to seal the periapical area from the oral environment. The first surgical attempt failed, but the second, which used a pedicle graft and a frenectomy, was successful. This case involved an endodontic problem with periodontal ramifications. Treatment consisted of a combination of endodontic and periodontic therapy.