Dentaltown January 2025 - 43

Discussion
As Chugal et al. have explained, " the
major biologic factors infl uencing the
outcome of endodontic treatment
appear to be the extent of microbiological
insult to the pulp and periapical
tissue, as refl ected by the ... magnitude
of periapical pathosis. " 8 In other words,
the more bacteria that are present, the
longer they have been present and the
larger the periradicular radiolucency,
the more thorough the debridement
and disinfection must be.
Incomplete disinfection may lead
to a lack of healing, disappointment
and inappropriate diagnoses. Long
and thorough irrigation using sodium
hypochlorite and the use of calcium
hydroxide intracanal medicaments are
critically important in cases with longstanding
or large lesions. Active irrigation
systems may also be helpful.9
Non-healing cases should not be
consigned to a diagnosis of VRF
unless a crack has been visualized or
proven beyond a reasonable doubt.
For example, a J-shaped radiolucency
alone is not cause to diagnose a VRF.
Furthermore, failure to heal after
NSRCT is much more likely to result
from insuffi cient disinfection than a
VRF. Non-healing initial NSRCT cases
should generally receive meticulous
nonsurgical retreatment.10
Conclusion
A tooth should not be condemned
to extraction unless a vertical root
fracture has been visualized or
proven beyond a reasonable doubt.
Re-treatment of a case that has failed
to heal is recommended if a fracture
can't be confi rmed visually on the
external root surface or in the pulp
chamber and canals. Every eff ort
should be made to ensure maximum
disinfection, no matter which technique
is used. Every patient is happy
to save a tooth, and their happiness is
our great reward. DT
References
1.
2.
Torabinejad M et al. " Outcomes of Root Canal Treatment
and Restoration, Implant-Supported Single Crowns, Fixed
Partial Dentures, and Extraction Without Replacement: A
Systematic Review. " Journal of Prosthetic Dentistry, Vol. 98,
2007, pp. 285-311.
Iqbal M, Kim S. " For Teeth Requiring Endodontic Treatment,
What Are the Diff erences in Outcomes of Restored
Endodontically Treated Teeth Compared to ImplantSupported
Restorations? " International Journal of Oral and
Maxillofacial Implants, Vol. 22, Suppl., 2007, pp. 96-116.
3.
Cohen S, Blanco L, Berman L. " Vertical Root Fractures:
Clinical and Radiographic Diagnosis. " Journal of the
American Dental Association, Vol. 134, Apr. 2003, pp.
434-441.
4.
5.
6.
Culjat MO et al. " Ultrasound Crack Detection in a Simulated
Human Tooth. " Dentomaxillofacial Radiology, Vol. 34, 2005,
pp. 80-85.
Tang W, Wu Y, Smales RJ. " Identifying and Reducing Risks
for Potential Fractures in Endodontically Treated Teeth. "
Journal of Endodontics, Vol. 36, 2010, pp. 609-617.
Liao WC et al. " Clinical and Radiographic Characteristics
of Vertical Root Fractures in Endodontically and
Nonendodontically Treated Teeth. " Journal of Endodontics,
Vol. 43, 2017, pp. 687-693.
7.
Patel S, Bhuva B, Bose R. " Present Status and Future
Directions: Vertical Root Fractures in Root Filled Teeth. "
International Endodontic Journal, Vol. 55, Suppl. 3, 2022,
pp. 804-826.
8.
Chugal NM, Clive JM, Spångberg LS. " A Prognostic Model
for Assessment of the Outcome of Endodontic Treatment:
Eff ect of Biologic and Diagnostic Variables. " Oral Surgery,
Oral Medicine, Oral Pathology, Oral Radiology, and
Endodontics, Vol. 91, 2001, pp. 342-352.
9.
Susila A, Minu J. " Activated Irrigation vs. Conventional
Non-Activated Irrigation in Endodontics-A Systematic
Review. " European Endodontic Journal, Vol. 4, 2019, pp.
96-110.
10. Torabinejad M, White SN. " Endodontic Treatment
Options After Unsuccessful Initial Root Canal Treatment:
Alternatives to Single-Tooth Implants. " Journal of the
American Dental Association, Vol. 147, 2016, pp. 214-20.
Dr. Dan Boehne is a diplomate of
the American Board of Endodontics.
He received his DDS from the UCLA
School of Dentistry and completed his
endodontic residency at the VA Hospital
in Long Beach. He enjoys teaching and
has authored or co-authored several
articles and textbook chapters on
endodontic complications, endodontic
disinfection and the restoration of
endodontically treated teeth. He is
in full-time private practice limited to
endodontics in Dana Point, California.
Dr. Shane White is a professor of
dentistry at the UCLA School of Dentistry
in the section of endodontics. A native
of Ireland, he received his dental training
from Trinity College Dublin. He spent
several years in general practice and parttime
teaching in Dublin before moving to
California, where he received a master's
degree in oral biology and specialty
residency training in prosthodontics and
endodontics from UCLA, and a PhD in
craniofacial biology from USC. He enjoys
teaching, research and service. He has
held senior leadership positions at UCLA
and for the University of California system.
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