The Effect of Isthmus on Vertical Root Fracture in Endodontically Treated Teeth

Introduction: Vertical root fracture (VRF) from apical condensation of gutta-percha is a common failure mode in endodontically treated teeth. Virtually all previous studies of VRF are limited to 1-canal roots. In this study, we consider experimentally and 'analytically VRF in roots with 2 canals. Methods: The interior root morphology in mandibular molar teeth extracted from patients due to VRF or other reason was examined from a series of polished horizontal cross sections. A 2-dimensional fracture mechanics analysis was used to determine crack growth from the canal surface to the outer root surface and evaluate the apical load needed to cause VRF, F-max. Results: From a mechanistic viewpoint, the isthmus connecting root canals can be regarded as a natural weak plane or crack. The results expose the prime role of isthmus in reducing Fmax, from approximate to 50 N with no isthmus present to approximate to 10 N. Conclusions: Two-canal mesial roots are much more prone to VRF than 1-canal distal roots. We suggest that VRF may occur during clinical condensation of gutta-percha in mesial roots of mandibular molars as well as other roots with canals connected by isthmus.