Vertical root fracture (VRF) is a common reason for the extraction of root canal filled teeth. The accurate diagnosis of VRF may be challenging due to the absence of clinical signs, whilst conventional radiographic assessment is often inconclusive, CBCT is an accurate tool that detects the pattern of bone loss related to VRF. However, an understanding of the aetiology of VRFs, and more importantly, the key predisposing factors, is mandatory in identifying teeth that may be susceptible. The influence of access cavity design and root canal instrumentation protocols should be considered. The post-endodontic restoration of root filled teeth should be expedient and considerate to the residual tooth structure. Posts should be placed ‘passively’ and excessive ‘post-space’ preparation should be avoided.