Document Type : Systematic Review
Authors
1
Department of Endodontics, Dental School/Dental Research Center, Tehran University of Medical Sciences, Tehran, Iran
2
Department of Endodontics, School of Dentistry, Baqiyatallah University of Medical Sciences, Tehran, Iran
3
Associated professor of Endodontics, Tehran, Iran
10.30491/tm.2026.603535.1999
Abstract
Introduction: Patients with dental pain and swelling frequently present to emergency departments (EDs), where emergency physicians must distinguish urgent dental conditions from non-urgent ones. Vertical root fracture (VRF) is a diagnostically challenging condition that is often misidentified as an acute apical abscess or periodontal abscess, leading to inappropriate antibiotic use or delayed referral. This review synthesizes evidence on recognizing, triaging, and referring VRF for emergency clinicians.
Method: This systematic review was conducted through a broad search of electronic databases, including MEDLINE, PubMed, BVS (LILACS and BBO), Scopus, Web of Science, Cochrane Library, and Embase, from 1990 to 2025. We applied no language restrictions and checked the reference lists of all related articles.
Result: The searches identified 1,927 records. After removing duplicates and screening, 37 full-text articles were assessed, and 15 studies met the predefined eligibility criteria. The included evidence consisted predominantly of case reports, case series, and other small clinical studies. Because study designs, treatment protocols, and outcomes varied substantially, the findings were synthesized narratively.
Conclusion: Suspect VRF in patients with a history of root canal treatment who present with localized pain on chewing, a deep isolated periodontal pocket, or a sinus tract near the gingival margin. Dental specialists perform definitive treatment (bonding, bioceramic sealing, or intentional replantation), which is not an emergency department procedure. Emergency physicians should provide analgesia, reserve antibiotics for systemic involvement, and refer to a dentist or endodontist within 24–48 hours. Large-scale studies on emergency department diagnosis of VRF are lacking.
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