Implant-associated Vertical Root Fracture in Adjacent Endodontically Treated Teeth: A Case Series and Systematic Review

J Endod. 2016 Jun;42(6):948-52. doi: 10.1016/j.joen.2016.03.021. Epub 2016 Apr 19.


Introduction: This study aimed to report a possible effect of the presence of an adjacent implant on the development of a vertical root fracture (VRF) in endodontically treated teeth.

Methods: A series of 8 cases in 7 patients with teeth diagnosed with VRF after the placement of implants in the adjacent area is described and analyzed. In addition, a comprehensive literature search with strict inclusion and exclusion criteria was undertaken to identify additional clinical studies that assessed this clinical scenario.

Results: The case series analysis revealed that the time from implant placement to the diagnosis of VRF was between 5 and 28 months (average = 11 months). The majority of cases occurred in female patients who received 2 or more implants. Six of the 7 patients were older than 40 years, with an average age of 54 years. The majority of teeth with VRF were premolar or mandibular molar teeth (6/8 teeth). All fractured teeth had been restored with a crown and had a post present, and the quality of the root canal filling was determined to be adequate. The systematic review revealed that implant-associated VRF has not been investigated or reported in the literature yet.

Conclusions: Based on a systematic review of the literature, this case series, although limited in its extent, is the first clinical report of a possible serious adverse event of implant-associated VRF in adjacent endodontically treated teeth. Additional clinical studies are indicated to shed light on this potential phenomenon.

Keywords: Endodontically treated teeth; implant; vertical root fracture.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Bicuspid
  • Crowns
  • Dental Implants, Single-Tooth / adverse effects*
  • Female
  • Humans
  • Male
  • Molar
  • Root Canal Filling Materials
  • Root Canal Therapy / adverse effects
  • Tooth Crown
  • Tooth Fractures / diagnosis
  • Tooth Fractures / diagnostic imaging
  • Tooth Fractures / etiology*
  • Tooth Root
  • Tooth, Nonvital / etiology*


  • Root Canal Filling Materials