Vertical Root Fracture and Periradicular Periodontitis

Difficulty in visualizing vertical root fractures with periapical radiography is well established. This 46-year-old male patient presented for diagnosis and possible retreatment of the lower left second molar, which was endodontically treated three years ago by others.

The tooth was sensitive to percussion, bite stick and probed 6mm at the disto-lingual line angle. The medical history was not contributory
to his current dental condition. While the initial periapical radiograph [Figure A] demonstrated a slightly thickened periodontal membrane
space in the coronal third of the distal root, the full extent of the periradicular periodontitis associated with this root was not evident until
a contemporaneous focused-field, high-resolution CBCT was exposed. The CBCT images [Figure B (axial) and Figure C (sagittal)] clearly show the vertical root fracture [green ellipse], and the full extent of the associated periradicular periodontitis [yellow arrow], respectively. Extraction was
recommended, avoiding an exploratory procedure to attempt to visualize the vertical fracture.

Testimonial:
The CS 9000 3D system creates small field of view images at low dose with sufficient spatial resolution for applications in endodontic diagnosis, treatment guidance and post treatment evaluation. In this case, we were able to accurately assess the condition of this previously treated molar and the associated boney defect, not visible using planar radiography. These findings were reassuring for our patient and the referring general dentist, and facilitated our treatment decision without an exploratory procedure.