Fracture diagnosis
27/04/2025
Fellow
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In endodontics, we have many tools that can help us diagnose a fracture.
In this article, we'll review how magnification, CBCT, dyes, periodontal probing, and visual observation help us diagnose fractures.
Fig. 1
CBCT can help us, showing a punctual bone loss, that may coincide with the fracture line. So we should look for the fracture in the wall of the tooth where the bone loss is.
For example, in this case, we can see the bone loss in de distal area, matching with the clinical picture
Fig. 2
The punctual periodontal probing can be another tool that could be useful to diagnose a fracture
Fig. 3
Blue methylene is a die that we can use, since when it penetrates the fissure, it makes it easier for us to identify it and allows us to assess its extension.
Its important to remove the filling materials when we cannot visualize the fracture, but we have but we have strong suspicions that it is.
For example in this case, the fracture wasn’t visible in the crown, but its clearly visible, in the entrance of the palatal canal.
Fig. 4
About the author, Alberto Morales Cuéllar:
Degree in dentistry at the Complutense University of Madrid, 2013
Master in Advanced Endodontics at Rey Juan Carlos University, 2017
Master Periodontics and soft tissue management at CEU Cardenal Herrera, 2020
Professor of Master of Microscopic Endodontics and Apical Surgery (URJC)
Opinion leader of Zarc4Endo
Style Italiano Endodontics Fellow member
Full member of the Spanish Association of Endodontics.
Member of the American Association of Endodontists.
Winner of the Best Training Presentation of the College of Dentists of Madrid
Conclusions
It's important to manage all the tools we have available in Endodontics to diagnose. Specially in cases of fractures, since the prognosis of these treatments can be very compromised, and an error during diagnosis can lead to failure after treatment. Stains, periodontal probing, CBCT, and magnification are extremely important in this cases.
Bibliography
PradeepKumar AR, Shemesh H, Nivedhitha MS, Hashir MMJ, Arockiam S, Uma Maheswari TN, Natanasabapathy V. Diagnosis of Vertical Root Fractures by Cone-beam Computed Tomography in Root-filled Teeth with Confirmation by Direct Visualization: A Systematic Review and Meta-Analysis.
NAKANO Kiwako, HAGIYA-KAWAMURA Yoko, KANEKO Mitsuhiro, KIKUCHI Izumi, YOSHIOKA Takatomo, SUDA Hideaki. Effects of methylene blue dye staining on the diagnosis of root fracture
K Komatsu, Y Abe, T Yoshioka, H Ishimura, A Ebihara and H Suda. Differential diagnosis of vertical root fractures using reconstructed three-dimensional models of bone defects
