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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 - RafaŽl Hi Ahmad, It is certainly not ideal. However, I agree with RafaŽl 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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