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20 I I case report _ root fractures _Longitudinal root fractures are confusing to boththeclinicianandthepatient,anditisoftenmore a case of prediction rather than diagnosis. In order to provide a global terminology and to prevent bias, five types of root fractures with different treatment modalities have been classified, from least to most severe:crazelines,cuspalfractures,crackedteeth,split teeth and vertical root fractures (VRFs).1 Craze lines, which are asymptomatic, affect only the enamel and often do not need to be treated. Cuspalfracturesonthecuspsandthecervicalmargins of the root are usually reinforced by a crown or an onlay restoration to keep the separated segments in their original positions. A cracked tooth occurs on the crown with variable symptoms. Cuspal reinforced restorations represent an appropriate treatment modality. If the fracture continues to develop, a split tooth is formed and wedging of the separated frag- ments can be identified visually and clinically with pain in mastication. If the fracture lies through the middle to the cervical third of the root without ex- tending apically, the mobile segment can be removed and the tooth can be preserved. Crown lengthening and orthodontic extrusion of the remaining root are further treatment alternatives.1 A VRF is the most severe type of longitudinal defect,originatingfromtheapicalendoftherootand continuing coronally. A VRF extends to the periodon- tal ligament and soft tissue grows into the fractured fragmentsovertime.Astheseparationsbetweenfrac- tured fragments increase over time, resorption areas become enlarged, which has a negative effect on the prognosis of the affected area for further treatment.2 Thus,arapiddecisionisrequiredtopreventadditional bone loss, which might cause difficulty in recon- structing the area for further treatment, such as im- plant placement. Clinical signs, radiographic features and symptoms observed in VRFs are very similar to thoseinafailedroot-canaltreatmentandmanifesta- tions of periodontal disease, making an accurate diagnosis difficult.3 Referring these patients for peri- odontal therapy or endodontic retreatment results in a loss of time and patience, as well as greater bone resorption. Today, the three major indications for the extrac- tion of endodontically treated teeth are unrestorable teeth (43.5%), endodontic failures (21.1%) and VRFs (10.9%).4–6 Recently, high prevalence rates of VRFs have been reported.2,4–6 A VRF can be treated by many treatment modalities, such as tooth extraction, removal of the fractured root and replantation of the tooth after bonding the fractured fragments extra- orally.4,7–9 Figs.1a–d_Anintra-oralradiography imageofanexperimentallyinduced VRFof0.4mmthickness(a).Arrows indicatetheVRFanditisdifficultto determinewhetherthefractureison thebuccaloronthepalatinalroot.CBCT imagesofanexperimentallyinduced VRF,axialview(b).NotethattheVRF obviouslyincludesthepalatinalroot andthisfindingmaychangethetreat- mentmodality.Sagittalviewshowing theextentoftheVRF(c).Coronalview (d).Arrowsshowthefracturelines throughtheentirerootsurface. roots1_2011 ӗ Diagnosis of vertical root fractures using CBCTand an alternative treatment modality Author_ Dr Senem Yigit Özer, Turkey Fig. 1a Fig. 1b Fig. 1c Fig. 1d