3D technology has been applied in both surgery simulation and guidance in endodontic microsurgery. Treatment options are still limited for vertical root fracture (VRF) in inaccessible areas that require accurate resection, especially in single-rooted teeth. This case illustrates successful treatment based on 3D technology. The literature on endodontic microsurgery of VRF is summarized. A 27-year-old woman presented with periapical lesions and apical root resorption of a maxillary premolar. After endodontic microsurgery was arranged, unexpected VRF was discovered through CBCT. Using a 3D-printed template, the root fracture was precisely removed with minimal damage. A literature review revealed a total of 12 articles published since 1946 on this topic. The 3D-printed template facilitated endodontic microsurgery, indicating reliable location of the root fracture and reduction in iatrogenic injury.