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Sadly lost due to fracture:periapical and interradicular lesions - Courtesy ROOTS
The opinions within this web page are not ours. Authors have been credited for the individual posts and images where they are.

From: Maarten Meire
Date: Thursday, April 3, 2008 12:29 pm
Subject: [roots] sadly lost due to fracture...
To: ROOTS

I think I posted this case some months ago. Yesterday the guy came in for recall. He was glad to come,
because 1 week ago he had bitten on a sandwhich containing a wooden stick (you know the kind of
toothpicks they use to keep sandwhiches together). After that, the tooth had become sore and even some
swelling had occurred.

A radiograph showed satisfactory healing of the periapical and interradicular lesions.

Unfortunately, periodontal probing distobuccal: >8mm. A vertical fracture was evident when taking
a closer look.

Although I noticed a small fracture line in the dentin at the first time, I thought it was
insignificant because I could not track it into the root dentin. Very likely, it was this fracture that
was the cause of necrosis of  this otherwise sound tooth.

Could this one be saved by a full crown? Do you always advise full coverage in cases like this
(only an access cavity)?

Comments are very welcome, Best regards, - Maarten.

Sad story Maarten, a well done endo gone to trash.... that's why i allways recomend crowns after endo treatment. i had failures like this, and those failures kept me enough motivated to persuede referals to do crowns over every treatment of mine - Sergiu Nicola Who knows if a crown would have prevented the progression of the disease in this case? As Maarten, says why would a sound tooth become necrotic? It was probably fractured at a sub clinical level during the initial treatment. I think the predictable management of fractured teeth, and most molars are fractured to some degree, is one of the biggest challenges we face. I have seen too many go the way of stainless steel and sunshine, that I am now quite cautious at initial consultation and will do a thorough perio probing of every tooth I treat. Any fracture into a canal and I think we are living on borrowed time, it's then the pt's choice if they want to gamble. Sometimes that gamble isn't worth taking. I'd love to be able to do a proper study of this with the cases I see in practice. - Bill Great photos.....great case for learning. Tooth needs a crown on these as soon as possible, reduce occlusion, put a band on the tooth. Temporize the tooth with a temp crown. All will help. - Glenn Sergiu, you sound sad to see that the "root canal treatment is gone to trash"... not that "the tooth itself had to be extracted"... Marcos Arenal well, i recomend cuspal protection in every cases, and that means crowns to me. no inlays, no onlays, crowns - Sergiu Nicola Maarten.. thats ushc a beautiful endo.. its interesting where it fractured though... im starting to wonder about 06 taper and how much root is left. Combine that with mesial SLA and i wonder what the long term mchanical implications are... i spose if you crowned it we wouldnt be having this conversation... but it used to be considered acceptable to not crown if either marginal ridge hadnt been breached... no more with our modern preparations i guess - Oliver Jones marteen, i just refused a tooth today:) i was having your case in my mind right when i saw the xray - Sergiu Nicola

Thank you Sergiu and others for your input! It seems that opinions vary here, but I agree that in this case, a full crown might have prevented or postponed propagation of the crack. Another colleague told me that the radiolucent halo around the distal root, visible on the pre-op X ray, is typical for a vertical root fracture all the way down. I doubt that, because 1) I've learned to always probe around every tooth prior to any treatment, which yielded no abnormal readings, and 2) If it were a complete fracture, wouldn't there be massive sealer extrusion since it was warm vertically condensed? I also agree with Bill that there is need for scientific background concerning the crack issue. Have you been thinking about the methodology for such a study, Bill? - Maarten

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