PART 1 OF 2 Don't Jump Extractions to An endodontic care series reveals the risk of root fracture misdiagnosis BY DRS. DANIEL J. BOEHNE AND SHANE N. WHITE Introduction Most diseases of pulpal origin result from bacterial ingress related to caries and its restorative sequelae. Nonsurgical root canal treatment (NSRCT) is extremely eff ective in treating diseases of pulpal origin. Very high long-term success and survival rates are widely reported.1, 2 Patients want to save their natural teeth, and the natural state must be preferred to the alternatives of tooth loss or tooth replacement.1 Pulpal and periradicular diseases can also originate from vertical root fractures (VRFs). A VRF can provide a pathway for oral bacteria to reach the pulp and the periodontium along the crack. Unlike root canal systems, VRFs cannot be adequately cleaned of bacteria, disinfected and sealed. Nor can a VRF be predictably mended. Th is means that teeth with vertical root fractures almost always require extraction, so arriving at the correct diagnosis is crucial. Vertical root fractures are notoriously diffi cult to 7 Th e routine comprehensive evaluation- diagnose.3- comprising the patient's history and symptomatology, testing the supporting tissues, pulp testing and radiography-may often be equivocal. Additional tests such as transillumination, use of the Tooth Slooth, staining with methylene blue to reveal cracks and microscopy may be helpful. Symptomatology such JANUARY 2025 | 36 | DENTALTOWN.COMhttp://www.DENTALTOWN.COM