Patterns of periodontal destruction associated with incomplete root fractures

Objectives: To clarify the differential radiographic diagnostics of teeth with incomplete root fracture. Methods: Information on 88 teeth with either a vertical root fracture without displacement of the fractured fragments (n = 22), a vertical periodontal defect (n = 22), a periodontal-endodontic lesion (n = 22) or an endodontic-periapical lesion (n = 22) was collected retrospectively from the patients' records. Results: Significant differences in the mean probing pocket depths were found between each of the four groups of lesions. Teeth with root fractures demonstrated smaller mean probing pocket depths than those with either periodontal or periodontal-endodontic lesions. Radiographic bone loss was significantly greater in teeth with periodontal and periodontal-endodontic lesions when compared with those with fractures. In teeth with vertical root fractures, there was no correlation between the probing depth and the radiographic bone loss (r = 0.01). The correlation coefficient between the greatest probing depth and alveolar bone loss was r = -0.16 in the fractured teeth, with higher values for the other three groups of lesions, 86.4% of the teeth with fractures had a complete root canal filling. Posts were present in 22.7% of the fractured teeth and in 13% of those with an endodontic periapical lesion. 91% of the teeth with vertical fractures were crowned or fixed-bridge abutments, Only 5% of the fractured teeth had no evidence of periapical bone changes. Conclusions: Incomplete root fractures mainly involve teeth which have undergone successful endodontic treatment. An isolated pocket on one aspect of a suspected tooth is reliably diagnostic for a root fracture.