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Pain with LR 1st molar #30
From: Ahmad Tehrani
To: ROOTS
Sent: Friday, May 15, 2009 3:33 AM
Subject: [roots] Endodontic case or Extraction?
Pt is a 68 Y.O. female.
Has pain with LR 1st molar #30.
Irreversible pulpitis case with lingering pain to cold.
would you recommend endo or extraction? - ahmad
Dear Ahmad, I would open it and look until where the
fracture line runs. If it runs deep into the root,
extract it. If it stays in the crown, do a RCT.
My 2 cents - Rafaël
Hi Ahmad, It is certainly not ideal. However, I agree with
Rafaël and I would open into the pulp chamber to check the
extent of the cracks before deciding to proceed or not.
Another thing - is that an open crown margin on the mesial
of 47? I would probably take a bitewing radiograph to
check as it may need to be replaced - Jonathan
Raf and Johnathan:
the crack runs in the canal.
No probing defects and segments aren't separable with a
metal instrument when wedged.
#47 crown is 20+ years old...not the best, but still
functional & asymptomatic.
#46 ( #30) is the symtomatic tooth - ahmad
Dear Ahmad, In these cases I check the perio status.
If there is a pocket associated with the crack I recommend
extraction. If not I open the chamber and see if the crack
runs into the canal. If it does, like in your case I also
recommend extraction. Of course I let the patient to decide.
There were not many times when the patient decided he wants
to give it a try (tightly monitored). In this case, I would
recommend extraction. Seems like there is good bone for
implant, why chance bone resorption if periodontitis
develops through the crack? - Thomas
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