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Dental Vertical Root Fractures: Value of CT in Detection

¹ Departments of Radiology (S.Y., A.G., R.D., F.M.K.)
² Oral Surgery (T.B.), University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria.

View larger version (126K): [in a new window]   Figure 1a. Fracture line of the first premolar confirmed surgically in a 61-year-old man. (a) Dental radiograph of the left upper jaw reveals vertical root fracture of the first premolar as a radiolucent line (arrowheads) that approximates the root filling. The apex of the root had been resected (large arrow). The periodontal ligament is enlarged (small arrows). (b) Magnified axial CT scan of the left upper jaw (original magnification, x4) reveals a buccolingually oriented root fracture of the first premolar (large arrow) that extends from the outer surface of the tooth to the surface facing the oral cavity. The adjacent segments are separated widely. The periodontal ligament is enlarged (small arrows).

View larger version (130K): [in a new window]   Figure 1b. Fracture line of the first premolar confirmed surgically in a 61-year-old man. (a) Dental radiograph of the left upper jaw reveals vertical root fracture of the first premolar as a radiolucent line (arrowheads) that approximates the root filling. The apex of the root had been resected (large arrow). The periodontal ligament is enlarged (small arrows). (b) Magnified axial CT scan of the left upper jaw (original magnification, x4) reveals a buccolingually oriented root fracture of the first premolar (large arrow) that extends from the outer surface of the tooth to the surface facing the oral cavity. The adjacent segments are separated widely. The periodontal ligament is enlarged (small arrows).

View larger version (174K): [in a new window]   Figure 2a. Fracture of the second premolar confirmed surgically in a 42-year-old man. (a) Dental radiograph of the upper jaw shows a root filling and post in the second premolar; no fracture line is visible. The periodontal ligament is enlarged (arrowheads), and there is a periapical area of radiolucency (solid straight arrow). Dental implants are seen in the first molar (curved arrow) and the second molar (open arrow). (b) Magnified axial CT scan of the left upper jaw (original magnification, x4) shows a mesiodistally oriented root fracture that extends from the surface closest to the midline (referred to as the mesial surface) to the opposite surface (referred to as the distal surface; arrow). The periodontal ligament is enlarged (arrowheads). There are no artifacts from the dental implants made of titanium.

View larger version (138K): [in a new window]   Figure 2b. Fracture of the second premolar confirmed surgically in a 42-year-old man. (a) Dental radiograph of the upper jaw shows a root filling and post in the second premolar; no fracture line is visible. The periodontal ligament is enlarged (arrowheads), and there is a periapical area of radiolucency (solid straight arrow). Dental implants are seen in the first molar (curved arrow) and the second molar (open arrow). (b) Magnified axial CT scan of the left upper jaw (original magnification, x4) shows a mesiodistally oriented root fracture that extends from the surface closest to the midline (referred to as the mesial surface) to the opposite surface (referred to as the distal surface; arrow). The periodontal ligament is enlarged (arrowheads). There are no artifacts from the dental implants made of titanium.

View larger version (135K): [in a new window]   Figure 3. Surgical finding of a fracture line of the buccal root of the first premolar not seen on the CT scans in a 63-year-old woman. Magnified axial CT scan of the right upper jaw (original magnification, x4) shows the first premolar has two roots: The buccal root (small arrow) is filled, and the palatine root (large arrow) has been replaced by a post. The metallic artifacts of the post overlie the buccal root and deteriorate the image quality. The fracture line cannot be detected.

View larger version (143K): [in a new window]   Figure 4. Surgical finding of a fracture line of the second molar not seen on the CT scans in a 48-year-old woman. Magnified axial CT scan of the right upper jaw (original magnification, x4) shows a very narrow diameter of the second molar root (arrows), which had been filled. No fracture line is detectable.