This 35 year-old male presented as an emergency with acute pain in the lower left quadrant. Obvious deep caries present in both #19 and #18. Tooth #19 was acutely painful to the touch. His general dentist told him that both teeth were non-restorable and needed to be extracted. He did not want to lose both of his teeth and asked what else he could do. They referred him to us. Completed root canal treatment with a “truss” access in two sessions and the tooth was asymptomatic prior to obturation. Tooth #18 did not expose the pulp so we just restored the cavity prep with a bonded resin. The patient is completely asymptomatic today. He does not wish to return to his general dentist.
At 35 years old, we should really be talking about saving these teeth in my opinion. Do we have 60 year implant outcomes yet? What if these teeth only make it until the patient is 60 years old? I feel much more comfortable with the patient proceeding with implant supported crowns at 60 than I do at 35. Just my opinion.
I simply cannot believe that not blowing this wide open, but instead preserving the truss between the B and L cusps as you have done here, does make the prognosis for this tooth 1000% better. Once restorative dentists start seeing how powerful this approach is to saving teeth, endodontists (except the most dogmatic) will come to understand that this approach shows endodontics in the BEST light —-as preservers of the dentition instead of as a “pre-implant procedure”.
gbc