Vertical root fracture (VRF) remains a diagnostic challenge because radiographic signs are often subtle, non-specific and influenced by imaging modality, fracture characteristics, artefacts and observer interpretation. This systematic review and meta-analysis assessed the accuracy of artificial intelligence (AI)-based models for VRF detection on cone-beam computed tomography (CBCT), periapical radiographs and panoramic radiographs and evaluated the certainty of evidence. This review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses of Diagnostic Test Accuracy Studies recommendations and was prospectively registered in International Prospective Register of Systematic Reviews. Studies evaluating AI-based models for VRF detection on dental imaging were included. Sensitivity and specificity were pooled using bivariate random-effects models when complete 2 × 2 contingency tables were available. Summary receiver operating characteristic curves were generated. Risk of bias was assessed using Quality Assessment of Diagnostic Accuracy Studies-2 and certainty of evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation approach adapted for diagnostic test accuracy. Post-hoc sensitivity analyses retained one representative dataset per study to assess the influence of multiple model-specific datasets. Six studies were included, of which 4 contributed to quantitative synthesis. The CBCT-based AI models showed high diagnostic performance under predominantly controlled or partially controlled conditions, with a pooled sensitivity of 85.3% and specificity of 89.0% (area under the curve [AUC]=0.921). The CBCT convolutional neural network-only subgroup showed sensitivity of 88.3% and specificity of 87.6% (AUC=0.929). Periapical radiograph-based models showed high sensitivity but limited specificity, with pooled sensitivity of 86.9% and specificity of 61.2% (AUC=0.708). The probabilistic neural network-only periapical subgroup improved sensitivity, but specificity remained limited. Sensitivity analyses confirmed preserved CBCT performance and persistently low periapical specificity. Panoramic radiography was assessed qualitatively because complete 2 × 2 data were unavailable. Certainty of evidence was moderate for CBCT and low for periapical radiographs. AI-based models show promising diagnostic potential for VRF detection, particularly on CBCT. However, current evidence mainly reflects performance under controlled or partially controlled conditions and should not be interpreted as definitive real-world diagnostic effectiveness. AI should currently be considered an adjunctive decision-support tool rather than an autonomous diagnostic method, especially for 2-dimensional imaging modalities. Prospective, multicentre clinical validation studies are needed.

The socket shield technique (SST) preserves peri-implant tissues during immediate implant placement in teeth with intact roots, yet its biomechanical behavior in the presence of vertical root fractures (VRFs) remains unquantified. This study evaluated the mechanical feasibility of a modified multi-shield SST (MS-SST) designed for single-fracture-line scenarios in maxillary central incisors. Three-dimensional finite element models representing conventional immediate implantation (CII), classic SST (C-SST), and MS-SST were subjected to 45° oblique occlusal loading from 10 to 100 N in 10 N increments. Bone and tooth structures were modeled as heterogeneous isotropic materials based on computed tomography gray values, whereas the periodontal ligament (PDL) was simulated using a nonlinear first-order Ogden hyperelastic constitutive law. Biomechanical metrics included von Mises stresses on the implant and abutment, displacements of the shield and PDL, hydrostatic pressure in the PDL and peri-implant bone, and strain energy density (SED) of the peri-implant bone. Comparative response patterns remained consistent across all loading magnitudes. At the representative peak load of 100 N, CII produced the most unfavorable peri-implant bone response, with the highest hydrostatic pressure (compressive: 26.94 MPa; tensile: 37.67 MPa) and SED (0.0447 MPa). C-SST yielded the lowest peri-implant SED (0.0302 MPa) and implant-abutment stresses. MS-SST exhibited intermediate SED (0.0347 MPa) and stress magnitudes, while reducing adverse peri-implant bone mechanical indicators relative to CII. Although MS-SST generated higher tensile hydrostatic pressure within the PDL than C-SST (0.0304 vs 0.0166 MPa), shield displacement remained comparably low (0.0101 vs 0.0104 mm). Within the assumptions of this finite element model, MS-SST appears mechanically feasible as a compromise design for vertically fractured maxillary central incisors when preservation of an intact buccal shield is not possible. Buccal shield segmentation did not markedly compromise shield stability and reduced adverse peri-implant biomechanical environment relative to CII. Further experimental and clinical validation remains necessary.

Root fractures in adolescents present unique esthetic and prosthodontic challenges, especially when complicated by oblique or vertical fracture lines that preclude traditional root submergence. A 15-year-old female sustained multiple traumatic dental injuries, including a complex root fracture of the maxillary left central incisor, following a motor vehicle accident. Polytrauma management included pulpal therapy, splinting and interim prosthesis fabrication, but the incisor demonstrated both horizontal and vertical fracture components, contraindicating conventional root submergence therapy. Socket shield therapy (SST) ridge preservation enabled buccal bone retention while minimizing the patient's surgical burden, thereby facilitating immediate removable prosthesis fabrication and esthetic rehabilitation. The preserved shield will facilitate future implant placement during adulthood without requiring grafting. This case highlights SST as a conservative pediatric trauma management strategy, providing immediate esthetic reassurance for the adolescent patient and reducing trauma-related distress during a critical developmental stage.

Dentinal microcrack formation during root canal preparation is a critical concern as it predisposes to vertical root fracture and treatment failure. Therefore, it is of interest to evaluate microcrack formation after instrumentation with three nickel-titanium systems (ProTaper Gold, WaveOne Gold and HyFlex EDM) using high-resolution micro-computed tomography. Hence, sixty human mandibular premolars (n=20 per group) were scanned pre-and post-instrumentation and microcracks were assessed for number, length and depth by blinded examiners. WaveOne Gold showed the highest microcrack formation, ProTaper Gold demonstrated intermediate values and HyFlex EDM exhibited the least dentinal damage, with statistically significant differences among groups (p<0.05). Heat-treated NiTi instruments produced fewer microcracks, indicating that file design and kinematics significantly influence dentinal integrity during root canal preparation.

Vertical root fracture (VRF) is one of the most challenging complications in endodontic treatment. Diagnosing VRF, especially in the early stages, can be difficult, and it is often recognized only during surgical procedures or on high-quality cone beam computed tomography (CBCT) scans. Cracked teeth and VRF represent a rising concern in endodontic management. Tooth extraction for single-rooted teeth and root amputation for multi-rooted teeth are still the last solutions suggested. The most important issue with VRFs is that the fracture line lies below the level of the epithelial attachment, allowing salivary microorganisms to penetrate the fracture space, thereby making the likelihood of fracture repair and the resulting lesion very poor. This paper aims to review the etiology, diagnosis, clinical symptoms, and present the surgical management of two cases of VRF.

Objectives: This study aimed to assess and compare the fracture resistance (FR) of teeth with simulated root perforations repaired using NeoMTA 2, NeoPUTTY, and Biodentine. Methods: Sixty-five single-rooted human teeth were decoronated to a standardized length of 13 mm from the apex. Their weight, mesiodistal (MD) and buccolingual (BL) dimensions were recorded for even distribution across five groups (n = 13). The teeth in the three experimental groups were instrumented. Standardized 1 mm perforations were created on the buccal root surface at a fixed 105° angle using a precision apparatus. The canals were then obturated with gutta-percha and AH Plus sealer. The perforations were subsequently repaired with NeoMTA 2, NeoPUTTY, or Biodentine. The positive control (PC) group included instrumented and perforated roots, while the negative control (NC) group comprised untreated, intact roots. All control group data used in this study were derived from previously published research. Fracture testing was conducted with a universal testing machine applying a compressive vertical load at 1 mm/min until fracture occurred. The forces were analyzed using one-way analysis of variance (ANOVA), followed by a post hoc Tukey test. Results: The mean fracture loads were as follows: NC Group: 342.68 ± 146.45 N, PC Group: 212.66 ± 77.89 N, NeoMTA 2 Group: 314.34 ± 131.41 N, NeoPUTTY Group: 243.76 ± 93.71 N, and Biodentine Group: 263.73 ± 94.63 N. No statistically significant differences were observed among experimental groups (p > 0.05). Conclusions: The three biomaterials showed similar strengthening effects but did not fully restore fracture strength.

Vertical root fracture represents a challenging clinical condition that is frequently associated with poor prognosis and often leads to tooth extraction as the treatment of choice. However, alternative therapeutic approaches aimed at preserving natural dentition should be considered. This report presents a clinical case of root amputation in a mandibular molar 4.6, which was diagnosed as a complete vertical root fracture based on clinical and radiographic findings. As an alternative to extraction, root amputation of the affected mesial root was performed. The evaluation of this treatment modality remains challenging due to the heterogeneity of clinical criteria and indications reported in the literature. Nevertheless, root amputation may represent a favorable therapeutic option in selected cases, particularly in molars presenting with a localized vertical root fracture involving a single root. This case highlights the potential of conservative surgical approaches to achieve long-term preservation.

Background: Cracked teeth may present with variable and atypical symptoms, sometimes mimicking non-odontogenic orofacial pain conditions, making diagnosis challenging, particularly when cracks appear limited to enamel. Case presentation: A 36-year-old woman presented with intermittent pain in a mandibular molar radiating to the ipsilateral temporal region. Clinical examination identified a crack line on the lingual surface of the mandibular first molar. Pulp sensibility testing (cold test and electric pulp test), occlusal loading tests, and cone-beam computed tomography (CBCT) were performed. CBCT was used primarily to exclude vertical root fracture and periapical pathology, and no radiographic abnormalities were identified. Differential diagnosis was conducted using structured diagnostic frameworks, including the International Classification of Orofacial Pain and the International Classification of Headache Disorders (3rd edition). Diagnostic local anaesthesia eliminated both biting pain and referred pain, supporting an odontogenic source. Collectively, the findings suggested that the enamel crack was the most likely source of odontogenic pain, although a definitive causal relationship could not be established. Because pulp sensibility remained normal, conservative management was selected. Crack sealing with a methyl methacrylate-based adhesive resin resulted in complete symptom resolution that was maintained throughout a 3-year follow-up period without the need for root canal treatment. Conclusions: Although the diagnosis remained probabilistic, the structured diagnostic approach, together with the favourable clinical response after crack sealing, supported the enamel crack as the most likely source of odontogenic pain.