Present status and future directions: vertical root fractures in root filled teeth

Vertical root fracture (VRF) is a common reason for extracting root-filled teeth. The accurate diagnosis of VRF may be challenging due to the absence of clinical signs, whilst the conventional radiographic assessment is often inconclusive. However, an understanding of the aetiology of VRFs, and more importantly, the critical predisposing factors, is crucial in identifying teeth that may be susceptible. The prevalence of VRFs in root-filled teeth is significantly greater than in teeth with vital pulps, demonstrating that the combination of loss of structural integrity, presence of pre‐existing fractures and biochemical effects of loss of vitality is highly relevant. This narrative review aims to present the aetiology, potential predisposing factors, histopathology, diagnosis and management of VRF and present perspectives for future research. The prevention of VRFs is critical; identifying susceptible teeth, utilizing conservative endodontic procedures, and practical and appropriate post‐endodontic restorative procedures is paramount to reducing the incidence of terminal VRFs.