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 fractures (SVRFs) and assessed its diagnostic accuracy for vertical root fractures (VRFs). Methods: A prospective cohort of 115 SVRFs meeting inclusion criteria was analyzed. Teeth were independently evaluated by two endodontists and categorized into three pre-endoscopic treatment groups: 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 subjects, and treatment plans were reassigned based on findings. Definitive VRF diagnosis was confirmed by intraoperative crack identification or clinical failure within a 1-year follow-up. Three cases were excluded due to loss to follow-up. Results: Periodontal endoscopy reduced unnecessary nonsurgical treatment by 39.58% (19/48) and surgical treatment by 64.28% (36/56), while improving diagnostic accuracy by 49.1%. The sensitivity of periodontal endoscopy for VRF detection was 88.1%. Conclusions: Periodontal endoscopy enhances clinical decision-making and significantly reduces unnecessary nonsurgical and surgical interventions in SVRFs.