root fracture

Many dentists are aware of the classic signs of a vertical root fracture such as (1) pain on biting/release (2) a “J-shape” radiolucency, or (3) focal deep periodontal probings. These signs and symptoms typically occur due to a coronal crack that extends apically. This case represents none of the classic hallmarks. Due to the large threaded post and a slight thin defect on the palatal root apex noted on CBCT, there was some suspicion of a possible root fracture, but the suspicion was relatively low given that there was solid crestal bone around the entire coronal 1/2 of the root. Below you will see an unusual circumstance where the root fracture actually started at the apex and was migrating coronally, thereby explaining solid crestal bone without focal periodontal probings or a “J-shape” radiolucency despite a root fracture. Without a high powered microscope, diagnosis would have been impossible as this fracture was on the palatal surface of the palatal root and access for an apicoectomy was done on the buccal. An implant would have been ideal in this situation, but the patient elected to pursue FPD.

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