April 2020 – Severe Attrition – Endo Indicated?

Severe Attrition – Endo Indicated?

Here is an example of a fairly young patient  in his early 20s with very severe attrition. We can see that the molars on the left hand side have pretty much lost all of their buccal tooth structure. The occlusal surface has been restored with composite. I was asked to perform Endodontic treatment on tooth #s 26 and 27 due to elevated thermal sensitivity caused by the extensiveness of the restorations and proximity to the pulp .

The question remains “Why is this young patient having such severe attrition?” and “Will Endodontic treatment do anything to alleviate the real problem which is the abnormal wear?”

The other obvious consideration is: “How are we supposed to restore these teeth with virtually no vertical height and complete over closure in this part of the mouth?”

So we have to ask:”Is it within the scope of the practice of the Endodontists performing endodontic treatment on these teeth to ask about the treatment plan and whether adjunctive treatment such as Orthodontics or Orthognathic surgery will be performed to provide the necessary vertical dimension to allow these teeth  to be restored properly?

Ultimately, the success or failure of the rehabilitation (and often of the Endodontics) will depend on the integrity of the overlying restorations and answering these questions BEFORE the referral is sent. If we simply “dispense” endodontic treatment because the pulps are sore, are we really doing the patient any favors? Is this the right thing to do and who makes that decision?

Figure 1: Endodontics complete

How are these tooth going to be restored?
How will this affect the long term retention in the mouth?