The preservation of teeth with root-originated fractures

Traditionally, when a root-originated fracture (ROF) was diagnosed in an endodontically treated tooth, the tooth was scheduled for extraction. However, modern endodontics offers new treatment options to manage and maintain certain ROF teeth. The decision of whether to extract a ROF tooth and substitute it with a dental implant, or to implement a more conservative management approach by attempting an additional endodontic treatment aimed to preserve the natural tooth, is complicated and multifactorial. The management alternatives of ROF teeth range from a traditional root amputation in multi-rooted teeth to modern endodontic surgical modalities that may enable the preservation of a fractured tooth. This required decision-making process includes prosthetic, periodontal, esthetic, endodontic, and patient value concerns.