What is the recommended treatment for a vertical root fracture with radiolucency at the apex?

For a vertical root fracture accompanied by radiolucency at the apex, extraction is considered the most appropriate treatment option. When a vertical root fracture occurs, it typically leads to the disruption of the tooth's structural integrity and can result in compromised prognosis, especially when there is associated radiolucency indicating possible infection or bone loss.

In such cases, the prognosis for retaining the tooth is usually poor, and attempts to salvage the tooth through methods like endodontic retreatment or other conservative approaches may not yield satisfactory results. The presence of a radiolucent area suggests significant pathological changes, making extraction necessary to eliminate the source of infection and to allow for the healing of surrounding structures. After extraction, it may also be possible to consider bone grafting in the area if needed for future restorative procedures, but that is a separate consideration post-extraction.

The other options, like observation, might be applicable in less severe cases, but in the presence of a vertical root fracture and significant radiographic findings, waiting would not be advisable due to the risk of progression of infection and further bone loss.