Endodontics · single question
A patient has pain on biting, 9mm probing depth, and an FPD present. Although not classically J-shaped, the X-ray finding is consistent with — what is the most likely diagnosis?
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Correct answer: A. Vertical Root Fracture
Vertical Root Fracture (A). The classic signs:
• Pain on biting (intermittent, localized)
• Deep, narrow probing defect (9mm isolated probe depth — 'sinus tract' pattern following fracture line)
• 'J-shaped' or halo-shaped radiolucency extending from apex to crestal bone along the root — pathognomonic for VRF
• Present under a crown/FPD (masking the fracture clinically)
• VRF in endodontically treated teeth: common after excessive post preparation, overzealous lateral condensation, or in teeth with thin roots.
• Prognosis: hopeless — extraction is typically required.
• Diagnosis: CBCT (gold standard for detecting VRF), clinical probing, staining with methylene blue, direct visualization.
• Pain on biting (intermittent, localized)
• Deep, narrow probing defect (9mm isolated probe depth — 'sinus tract' pattern following fracture line)
• 'J-shaped' or halo-shaped radiolucency extending from apex to crestal bone along the root — pathognomonic for VRF
• Present under a crown/FPD (masking the fracture clinically)
• VRF in endodontically treated teeth: common after excessive post preparation, overzealous lateral condensation, or in teeth with thin roots.
• Prognosis: hopeless — extraction is typically required.
• Diagnosis: CBCT (gold standard for detecting VRF), clinical probing, staining with methylene blue, direct visualization.