54 yr old male reported with pain and temperature sensitivity in relation to #18 for the past 1 wk. Had history of tooth fracture 3 moths back. Clinical examination revealed fracture of distobuccal cusp and deep distal fissure. Tenderness on percussion . No significant change evident in radiograph. Immediate response to cold test. Cracked tooth with irreversible pulpitis. Treatment planned – Root canal therapy and full coverage restoration.
Cracked tooth
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Revathi,
I am not an expert in fractured teeth, but here is my take. On fractures that extend and disappear into the distal on 2nd molars, my experience is that at 10 years many of them are gone. I suspect there are many co-variables to such a pessimistic prognosis, such as how the occlusion is, how it is managed, the type of restorations used, lateral interference’s, diet, and habits like bruxism. So they are a management problem as well as an endodontic problem. To the extent you can mitigate some of these variables, you will have a better chance. The pictures indicate to me, there may be non-working interference’s present. I think I would flatten the occlusion now.
There is some evidence that “shrink-wrapping” such teeth with a bonded resin restoration may hold better promise. Look up some of David Clark’s material on this to get his take on it. The idea is to minimize tensile forces on the remaining tooth structure.
gbc
Thank you Dr.Carr
Pt reported today with the tooth fracture – no option , had to extract
David Clark comments:
This is a neat case. The Calla Lilly and flattened Calla Lilly are great treatments for a tooth like this but the design as absolutely critical and the treatment not all that intuitive. A couple of the IAE guys are coming to Level 2 and Level 4. They will take away enough content to teach this technique to the TDO-ers.
Here, I’m not convinced that endodontics was necessary as a first step. Also, like David, I’m not convinced that a traditional full-coverage indirect restoration is the best call, and depending on who is doing it, it could easily make the tooth worse.
If I felt that endodontics was indicated, I would have managed the access and occlusal differently as well.
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That ’54 yr old male’ case sounds complicated! I’m reading this over my coffee break, and the emoji translator tool immediately came to mind. Seems like a good way to explain treatment plans to patients these days, haha! Imagine text to emoji translator in the dentist’s office!