Role of periodontal endoscopy in clinical decision-making for teeth with suspected vertical root fractures.

BACKGROUND: This study aimed to evaluate the role of periodontal endoscopy in clinical decision-making for teeth with suspected vertical root fracture (S-VRF) and to assess the diagnostic accuracy of this procedure with respect to vertical root fracture (VRF). METHODS: A prospective cohort of 115 S-VRFs meeting the inclusion criteria was analysed. The teeth were independently evaluated by two endodontists and subsequently categorized into three groups based on the type of pre-endoscopic treatment: flap surgery (S group, n = 56), endodontic treatment (R group, n = 48), and extraction (E group, n = 11). Periodontal endoscopic examination was performed for all the teeth, and treatment plans were reassigned based on findings. The diagnosis of VRF was confirmed by intraoperative crack identification or clinical failure within a 1-year follow-up period. Three cases were excluded because they were lost to follow-up. RESULTS: Compared with cone-beam computed tomography(CBCT), periodontal endoscopy was associated with a reduction in unnecessary nonsurgical treatment by 39.58% (19/48), reduced the incidence of unnecessary surgical treatment by 64.28% (36/56), and an increase in diagnostic accuracy by 49.1%.The sensitivity of periodontal endoscopy for VRF detection was 84.3%. CONCLUSIONS: Periodontal endoscopy may enhanced clinical decision-making and was associated with a reduced incidence of unnecessary nonsurgical and surgical interventions in patients with S-VRFs.