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Fracture on palatal: Tooth #23 - Courtesy ROOTS

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From: "Ilya Mer"
Sent: Tuesday, February 16, 2010 4:43 PM
Subject: [roots] What made the tooth become necrotic?

Patient came with emergency case, #23 was cause of pain. Cold 
test was negative, sensitivity to warm water and percussion +++.  
Pulp was necrotic and I performed routine protocol of abscess, 
shaping, irrigation and calcium hydroxide dressing. The pain was 
gone but what made the pulp become necrotic? I tried to stain the 
coronal part with caries marker. The only sign I have found was 
small fracture on palatal. What is your opinion? Best regards 
from  Moscow - Ilya Mer.

I have a lower cuspid in my own mouth that became necrotic 20 years after minor ortho and 1 year after minor trauma. Who know why these things happen but my guess is either trauma or ortho. With the lateral root canal treated, was there a history of trauma? Great case and great photos by the way - Paul Jones Great case, Ilya! Last week I had just the same case with tooh 21, cold test - negative, electric pulp test - doesn't respond, mild sensitivity to heat, no periodontal probing! The rascal had even a fistula! When I've opened the pulp chamber there was a lot of pus, pulp was necrotic. And I really do not know what was the cause for this necrosis - no trauma, no fracture...the tooth was intact! So maybe those kind of cases will remain a little mistery. I will post radiographs ASAP.- Bojidar Kafelov, Sofia, Bulgaria History of trauma, ortho, external bleaching, lasers? :) Good to rule out any and everything in the dental history regardless of how it may hurt someone's feelings. :):):) - Terry

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In Vivo mesial view

Inaccesible canals

Premolar 45

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Silver point

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Apical third

3 canal premolar

Severe curvature

Interesting anatomy

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Zirconia crown

Dycal matrix

Cracked tooth

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