Endodontic Microsurgery On Vertical Root Fracture With 24-Month Review

Vertical root fractures (VRFs) predominantly occur in endodontically treated teeth, particularly in young permanent teeth with thin radicular dentin. Microbial colonization of crack lines, often undetectable during initial stages, progressively leads to alveolar bone resorption and refractory periapical inflammation, traditionally mandating tooth extraction. Contemporary endodontic microsurgery incorporating bioceramic materials like iRoot BP Plus (Innovative Bioceramix, Canada) now offers a viable tooth-preserving alternative. This case report describes a mandibular first premolar with a persistent gingival sinus tract for three years following apexification and apical barrier. Clinical examination revealed neither isolated deep periodontal pockets nor obvious pathognomonic halo radiolucency. Microsurgical exploration identified an incomplete vertical fracture extending from the apical region to the cervical third of the root, which was successfully repaired using iRoot BP Plus. Postoperative evaluation at 5- and 24-month intervals demonstrated complete resolution of clinical symptoms with radiographic evidence of periapical bone regeneration. Early VRF diagnosis remains clinically challenging, requiring comprehensive assessment combining clinical examination and radiographic interpretation. Definitive diagnosis often necessitates surgical exploration to confirm the presence of root cracks. This case demonstrates that incomplete VRFs can be effectively managed through microsurgical intervention using advanced bioceramic materials. The findings indicate that microsurgical exploration serves as a valuable diagnostic tool for early VRF detection, while bioceramic-assisted repair offers a biologically favorable treatment alternative to extraction. Further clinical studies are warranted to establish long-term prognosis and case selection criteria for this conservative approach.