Vertical Root Fracture in Buccal Roots of Bifurcated Maxillary Premolars from Condensation of Gutta-percha

Introduction: Maxillary premolars are among the teeth most susceptible to vertical root fracture (VRF) from lateral condensation of gutta-percha. These teeth are distinguished by a complex anatomy of the buccal root including a large depression in the dentin wall facing the bifurcation. It is hypothesized that tooth sectioning coupled with 2-dimensional fracture analysis is instrumental in understanding VRF in such teeth. VRF was examined by tooth sectioning following the development of a fracture mechanics analysis to predict VRF in such roots. Methods: The fracture morphology in teeth extracted from patients because of VRFs was examined from a series of horizontal cross sections. 2-dimensional fracture mechanics analysis in conjunction with the finite element technique was developed to evaluate VRF caused by canal pressure (q). As in our previous single-rooted tooth model, the apical obturation force (F) was related to q using a simple formula. Results: Fracture was mostly limited to the buccal root, exhibiting some competing modes including fracture from the depression peak to the canal surface and the canal surface to the root surface, which may occur either along straight lines or curved trajectories resembling the depression outline. The analysis predicted clinical fractures well, yielding VRF force values in the upper range used by clinicians during lateral condensation of gutta-percha. Conclusions: The main etiology for VRF is stress concentration resulting from the combined effect of wedgelike canal depression and the flexibility of periodontal ligament tissue joining the root and bone. This drawback can be alleviated by minimizing canal enlargement and apical condensation force during root canal therapy.