Vertical root fractures in root treated teeth‐current status and future trends

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. Thorough clinical examination with magnification and co‐axial lighting is essential in identifying VRFs. Although CBCT cannot reliably detect VRFs per se, the pattern of bone loss typically associated with VRF can be fully appreciated, increasing the probability of correct diagnosis and management. Furthermore, 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, pre‐existing fractures and biochemical effects of loss of vitality are 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 expedient and appropriate post‐endodontic restorative procedures are paramount to reducing the incidence of terminal VRFs.