Lim Myung-Jin, Kim Jung-Ae, Choi Yoorina, Hong Chan-Ui, Min Kyung-San
Department of Conservative Dentistry, School of Dentistry, Chonbuk National University, Jeonju, Korea.
Department of Conservative Dentistry, School of Dentistry, Wonkwang University Dental Hospital, Iksan, Korea.
Eur J Dent. 2017 Jan-Mar;11(1):122-125. doi: 10.4103/ejd.ejd_160_16.
Although vertical root fracture (VRF) is mostly found in endodontically treated teeth, it also occurs spontaneously. If VRF is recognized after endodontic treatment, it is considered to be iatrogenic and can lead to legal trouble. However, legal problems can be averted if the dentist can prove that the VRF existed before endodontic treatment. This case report describes an unusual, spontaneous VRF in an endodontically treated tooth and presents a useful tip for determining whether a fracture is iatrogenic. We performed nonsurgical endodontic treatment on a mandibular first molar with irreversible pulpitis. After 6 months, the patient revisited with localized swelling, and we diagnosed VRF of the mesial root. We extracted the tooth and prepared it for microscopic examination. We found gutta-percha in the fracture line of the transversely sectioned root, and it appeared to have penetrated to the fracture line through the force generated from the filling. The patient was informed and agreed that the fracture occurred spontaneously before treatment. This case demonstrates the time point of VRF occurrence by identifying the presence of gutta-percha in the fracture line. We suggest that this procedure can be used to demonstrate whether VRFs in endodontically treated teeth are spontaneous or iatrogenic.
尽管垂直根折（VRF）大多见于接受过根管治疗的牙齿，但也会自发发生。如果在根管治疗后发现VRF，则被认为是医源性的，可能会引发法律纠纷。然而，如果牙医能够证明VRF在根管治疗前就已存在，那么法律问题就可以避免。本病例报告描述了一例发生在接受过根管治疗牙齿上的罕见自发性VRF，并提供了一个判断骨折是否为医源性的有用提示。我们对一颗患有不可复性牙髓炎的下颌第一磨牙进行了非手术根管治疗。6个月后，患者因局部肿胀复诊，我们诊断为近中根垂直根折。我们拔除了患牙并进行显微镜检查准备。我们在横断牙根的骨折线上发现了牙胶，并且看起来牙胶是通过充填产生的力渗透到骨折线的。我们告知患者并取得其同意，即骨折在治疗前就已自发发生。本病例通过在骨折线上发现牙胶确定了VRF发生的时间点。我们建议该方法可用于证明接受过根管治疗牙齿上的VRF是自发的还是医源性的。
