Sir, precisely identifying vertical root fracture (VRF) in endodontically treated teeth is very challenging and can cause needless suffering for patients and dentists if not diagnosed early.1 It requires diagnostic expertise and timely clinical judgement. Though it is believed that cone beam computed tomography (CBCT) plays a paramount role in the accurate identification and prognosis assessment of teeth with VRF, routine CBCT scans are not affordable or accessible to many patients, especially in developing countries. Moreover, the accuracy of CBCT imaging for the diagnosis of subtle VRFs in endodontically treated teeth in vivo has been reported to be poor, which questions the excessive dependence on CBCT.2,3 Therefore, giving critical importance to detailed history taking, meticulous clinical and radiographical examination remain the best diagnostic aids.4 The authors' experience points out two major diagnostic clues that can indicate a VRF early:

  1. 1.

    Bifurcation radiolucency in bone in mandibular molars

  2. 2.

    Presence of swelling with or without a sinus opening on the lingual aspect of an endodontically treated tooth.

These signs and symptoms can be an early indication for suspecting a VRF, which should become an affirmative indication for a further CBCT assessment. Early diagnosis will allow for a decision regarding extraction if indicated, as long-standing root fracture will result in excessive bone loss, which can impede or complicate any implant options in the future. Early signs, as discussed here, indicate high chances of a VRF, and identifying and responding to early signs is a wise choice as it is better to be early than to wait until it is too late.