False Endodontic Lesion with Periodontal Involvement
A VRF is a frustating accident for both the dentist and the patient, for several reasons. First, the diagnosis may be difficult because of a lack of specific clinical signs and symptoms and/or typical radiographic features. The differential diagnosis from endodontic or periodontic entities is a challenge.
Second, the fracture is usually diagnosed years after all endodontic and prosthetic procedures have been completed39. Presentation of the symptoms can be some time after the fracture has been produced. Third, several etiological factors may be involved.
Fourth, despite a lot of the professional's time and the patient's investment having been involved already, the prognosis of the tooth is frequently so poor that extraction is the only option40-42. Even worse, this extraction decision must be taken quickly in order to preserve as much bone housing as possible, especially if an implant is the future treatment of choice.
The frequency of VRFs has been reported as 11-20%. Maxillary premolars and mesial roots of mandibular molars are the teeth more affected.
There is a mixture of predisposing and iatrogenic factors. Predisposing factors include: unique anatomy like premolars; caries and trauma (which increases the risk for dentin cracks and later fracture propagation): moisture loss and degeneration of collagen fibers after endodontic treatment; extensive reconstructions; loss of alveolar support; and age.
Iatrogenic factors include: excessive coronal dentin canal removal in endodontic treatment; excessive pressure during lateral condensation of endodontic obturation; canal over-enlargement for unnecessary or wrongly designed posts; preexisting cracks); traumatic seating of intracanal restorations; occlusal traumatic restaurations; and badly adapted and leaking restorations.