Fractured Bicuspid/MIE

Fractured bi

I wanted to post this interesting case. She is the sister of an endodontist colleague( no pressure) who arrived in my office with a temp crown and in severe pain. As soon as I took a look, I realized the tooth had a bad MD vertical fracture with no probings or mobility but would likely need extraction. I opened the tooth and decided to do a dual access to remove the least amount of tooth structure in the most vulnerable spot, right where the fracture was running. My thought was, I would loose nothing in pushing the envelope. She returned 4 weeks later and was completely asymptomatic and able to bite and chew so she really wanted to give it a try. After I completed the case (04/ 20 preps on both canals) the tooth was on and off acting up. With the GD,  we finally agreed to extract it. The patient says after that appointment, the tooth never bothered her again. The final X-ray is an 18 month follow up. Tooth is completely asymptomatic and fully functional.

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Dr. Angela Noguera

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Cases like this prove how poor we are at prognosticating. We all recognize this tooth is probably history—but from the patient’s perspective, it seems to be working. AQnd as long as the patient understands we are just “buying her some time”, why not make the bet. I think all of us who have practiced for awhile have a very pessimistic view with this tooth. When, and if, the tooth comes out, we should ask the patient whether she feels it was worth the risk and expense. I think most patients would be appreciative of the effort. On the TDO side,… Read more »


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