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Q: Vertical Root Fracture of molar tooth ( Answered 4 out of 5 stars,   0 Comments )
Subject: Vertical Root Fracture of molar tooth
Category: Health > Conditions and Diseases
Asked by: mindsponge-ga
List Price: $20.00
Posted: 01 Aug 2003 23:31 PDT
Expires: 31 Aug 2003 23:31 PDT
Question ID: 238073
I searched the web to see if a "vertical root fracture" of a
multi-root upper molar tooth could be repaired.  It appears that it
may be possible to surgically remove the fractured root and save the
tooth.  My question is, are there any new (or old) ways to repair a
vertical tooth fracture, short of extracting the affected tooth or
root.  An acceptable answer could include information on successes
with traditional root canals.  I would prefer to see if there are any
truly new methods to repair such as glues, cements, etc.
Subject: Re: Vertical Root Fracture of molar tooth
Answered By: tlspiegel-ga on 02 Aug 2003 02:29 PDT
Rated:4 out of 5 stars
Hi mindsponge,

I'd like to direct your attention to the disclaimer at the bottom of
this page -
I am not a health practitioner, and all information was provided from
the Internet.  I do hope you're not in any pain, and there is strong
evidence that your tooth can be saved, but ultimately that will have
to be determined by either your dentist or the endodontist he refers
you to.

What is a vertical root fracture?

Fractures of the root which start below the gumline are called
vertical root fractures or split root.  Fractures begin in the root
typically near the end, and extend toward the chewing surface.  Other
than extraction of the tooth, root canal is generally performed

A fracture can occur below the gum line, vertically or horizontally in
the tooth. The level at which the root is fractured helps determine if
the tooth can be saved.

Your dentist can refer you to an endodontist (root canal specialist)
for evaluation of the tooth.  (The word "endodontic" comes from Greek,
like many other medical terms. "Endo" means "inside" and "odont" means
"tooth." Endodontists are the dental specialists who perform root
canal treatment.)

But there are other ways to treat the fracture... with a resin called
4META/MMA/TBB (Superbond®).



"Among these bonding agents, the 4-META/MMA/TBB adhesive resin may
show affinities for biological tissues. It is these properties which
can be used in the treatment of the root fracture of a vital tooth."


"In 1982, Masaka, a Japanese author and clinician, treated the
vertical root fracture of a maxillary central incisor in a 64 year-old
woman using an original material: adhesive resin 4META/MMA/TBB
(Superbond®). The tooth, treated with success, was followed for 18

Extending the applications of this new material,Masaka further
developed his technique in 1989 with the bonding together of fragments
of a fractured tooth after having extracted it and,then, subsequently,
re-implanting it. This last procedure, in addition to the extraction
and joining together of the fragments, also gave the author an
opportunity to rotate the root 180° around its longitudinal axis. This
positioned the destroyed tissue (periodontal alignment, alveolar bone)
facing healthy tissue (alveolar bone, periodontal ligament)
(Masaka,1982; 1985; 1995; Masaka and Irie, 1998). In 1989, after a
long period during which there was much documented use of Superbond
applied to the dentin of vital teeth, Masaka performed a direct pulp
cap (Masaka, 1991),and ascertained the preservation of pulpal
vitality. These results were confirmed by other authors who concluded
that the adhesive resin4-META/MMA/TBB displays a strong affinity with
the pulp with which is it capable of creating a biological joint
(Inoue and Shimono,1992; Miyakoshi, 1994).

The 4-META/MMA/TBB is a chemically polymerized resin which achieves,
at the same time, aliaison..."


Case Report From PubMed (subscription needed to view full text)
Replantation with intentional rotation of a complete vertically
fractured root using adhesive resin cement
Yoshiyuki Kudou, Minoru Kubota
"Abstract - This case describes intentional replantation with rotation
of a complete vertically fractured root using adhesive resin cement.
The fractured root was fixed with adhesive resin cement extra-orally.
The tooth was replanted into the socket with rotation in order to
avoid contact with the area where the periodontal ligament of the root
surface was lost and the area where the alveola bone was lost along
the fracture line. At follow-up 18 months later, the tooth was
asymptomatic and radiographically showed an increase in the density of
the alveolar bone, and the periodontal pockets were improved."


Restoration of fractured teeth a long-term study.

by David A. Hall, D.D.S.

In an earlier case report by the author, a central incisor in an
11-year-old male that was shattered into four pieces, was
restored.[11] The trauma had caused several vertical fractures which
traversed the gingival attachment. Eighteen months postoperatively, in
spite of pulpal involvement in the fractures, the tooth was still
vital and apparently completely healthy. However, subsequent to the
initial success of the treatment, the tooth was re-fractured in a
second traumatic incident. Upon examining the second injury, we were
able to separate the coronal portions of the injury very slightly, but
the resistance to separation of the radicular portions was consistent
with cementum healing having occurred over the first injury. Repair
was attempted after the second injury, but without long-term success.
Five years later, the tooth was extracted. However, the incident
suggested a possibility of true cementum healing of a vertical root


In the 1980’s, Masaka[12] developed a technique for preserving teeth
with vertical root fractures using a 4-META adhesive. He has extracted
fractured teeth, repaired them extraorally, and replanted them. While
his success validates the concept of root fracture repair, it doesn’t
address the issue of potential biological cementum repair. Aouate[13]
has also done work in similar vertical root fracture repair with
4-META in France.


Additionally, four cases have been presented with histories of from
nine to twenty-one years. Each case involved a tooth fracture that
extended from supragingival to subgingival areas. In each case, the
tooth continues to function for the patient with no periodontal

I present as a hypothesis, the following principles of successfully
restoring a root fracture:

1. The fracture must be treated immediately within a couple of days.

2. The reduction of the fractured pieces must be complete and perfect.

3. From the first day, the repair must be made absolutely stable.

4. If the above conditions are met, a fracture that extends below the
gingival attachment will eventually heal and will have an excellent
long-term prognosis. I hypothesize that the periodontal ligament cells
deposit new cementum over the fracture and thus, with proper healing,
there is no potential for infection from the fracture site.

There are several possible explanations for the need for immediate
reduction of the fracture. One may be that the fracture line can
become a nidus of infection. If enough time elapses before the pieces
are reduced, there is a possibility of tissue swelling or other debris
getting into the fracture site and not being able to be removed
completely, thus preventing perfect apposition of the fragments. The
space created then may provide a constant source of infection and
irritation that prevents complete healing. If, on the other hand, the
pieces can be brought into perfect re-alignment, the irritants are
minimized and the periodontal ligament can deposit new cementum over
the fracture, thus providing optimal healing.

Another factor at work may be the health of the periodontal ligament
fibers that are in the immediate proximity of the fracture. If, due to
the movement of the fractured segments, they continue to be
traumatized, healing potential could be compromised.


A Guide To Cracked Teeth

"Root fractures are cracks that extend onto and deep into the root.
They can exist in a horizontal or vertical plane. They exhibit fewer
signs and symptoms and therefore may go unnoticed for some time. You
may discover that you have a vertical root fracture when the bone and
gum surrounding the root become inflamed and infected. Treatment
usually involves extraction of the tooth, but sometimes endodontic
surgery can save a portion of the tooth."


Endodontic Associates Of Northern Colorado

Vertical root fracture: Vertical root fractures are cracks that begin
in the root of the tooth and extend toward the chewing surface. They
often show minimal signs and symptoms and may therefore go unnoticed
for some time. Vertical root fractures are often discovered when the
surrounding bone and gum become infected. Treatment usually involves
extraction of the tooth. However, endodontic surgery is sometimes
appropriate if a portion of the tooth can be saved by removal of the
fractured root.


Dental Reference
If The Nerve Is Dead, Do I Still Need a Crown?

Yes. You need a crown to stop the existing crack from spreading down
the root. This is called a 'vertical root fracture'.  Unfortunately,
this results in an untreatable occurrence and the tooth needs to be
extracted. Crowns are needed on dead teeth even more so than teeth
with living nerves (dead teeth are far more brittle.) Regardless of
how a nerve dies, crack or no crack, it is standard practice to put a
crown on a tooth that has had root canal treatment because of its
increased brittleness.


Vertical root fracture begins in the root. Fractured cusp, cracked
tooth, split tooth, and vertical root fracture are found most often in
posterior teeth."


Root Canal Therapy, Root Canals, or Non-Surgical Endodontic Therapy


The Endo Experience for Professionals

Vertical Root Fracture in Apparently Successful Case  (X-ray Photos
and description of procedure)


British Dental Health Foundation

"Why don’t cracks show up on a dental x-ray? 
Unfortunately, dental x-rays sometimes don’t show up the cracked
tooth. This is because the x-ray beam must be parallel to the crack
before it can penetrate it.

However, sometimes other signs of a crack may show up.  With a
vertical root fracture, if the crack has been there long enough,
vertical bone loss near to the root can be seen. Your dentist may use
a bright light or a magnifying glass to find the crack. They may also
use a special dye to follow the course of the crack."


Vertical Root Fracture

"There may be no practical way to save the tooth, making extraction
the only answer. However, all possibilities should be considered
before any tooth is extracted. The function of dentistry is to
maintain the integrity of the dental arch and to preserve the natural
tooth as much as possible."


Google Search:  vertical root fracture, resin repair vertical root
fracture, root canal, endodontics

Best regards,


Request for Answer Clarification by mindsponge-ga on 02 Aug 2003 13:08 PDT
Dear tlspiegel-ga,

Thank you for the answer.  It does appear that the 4META/MMA/TBB
(Superbond®) has worked.  It would be good to know if this material is
available to endodontists in the US.  Of course, I did not request
this additional information in my question, so you do not have to
follow up on this if you do not wish to do so.  I will hold off on my
rating for until I hear back from you. Thanks again for a good job.



Clarification of Answer by tlspiegel-ga on 02 Aug 2003 14:23 PDT
Hi mindsponge,

I'm going to assume the best way for you to determine if the resin is
available/being used in the US is to make some inquiries locally. 
Most references I found were from outside the US, however that does
not mean it isn't available in the United States.

I wish you good luck on the restoration of your vertical root
fracture.  :)

Best regards,


Clarification of Answer by tlspiegel-ga on 02 Aug 2003 22:12 PDT
Hi mindsponge,

Thank you very much for the tip ~ Good luck to you. :)  

Best regards,

mindsponge-ga rated this answer:4 out of 5 stars and gave an additional tip of: $4.00
Thanks again. Very prompt and on-target answer.

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