VERTICAL ROOT FRACTURE

Vertical root fracture (VRF) is a longitudinal fracture of the root that most frequently affects endodontically treated teeth, although it may also occur in vital dentition. As part of the cracked tooth spectrum, VRF presents significant diagnostic and therapeutic challenges due to its variable clinical manifestations and its resemblance to persistent endodontic or periodontal disease. The etiology is multifactorial, involving natural predisposing factors such as root morphology, occlusal loading, dentin aging, and pre existing microcracks, as well as iatrogenic factors including excessive dentin removal, obturation stresses, post placement, and inadequate restorative design. VRFs typically develop through a slow process of cyclic fatigue and structural weakening of radicular dentin, leading to longitudinal crack propagation and subsequent periodontal breakdown. Early and accurate diagnosis is essential to prevent unnecessary retreatment, progressive bone loss, and complications that may compromise future implant placement. Diagnosis should be based on a comprehensive assessment integrating patient-reported symptoms, clinical findings-such as isolated deep periodontal probing defects and coronally positioned sinus tracts-and radiographic evaluation.