Virgin Cracked Molar
Virgin teeth are extremely hard when the enamel is intact . However even virgin teeth can undergo fracture to the point where the pulp becomes involved. In this case a virgin mandibular second molar had a distal fracture running through the central developmental groove to the point the pulp eventually became involved. The pulp tissue underwent necrosis and the patient began to have symptoms.
After performing the usual pulp test to determine that the pulp was non responsive, transillumination showed blockage of the light source through the central developmental groove, indicating a mesial distal crack.
All probings were within reasonable limits so we chose to perform Endodontic treatment and try to put a crown on this tooth as soon as possible to prevent further migration of the fracture. This mandibular second molar also had unusual canal anatomy in that it had a C shaped canal. C shaped canal or single canal/single conical rooted mandibular molars with fractures generally have a poor prognosis but we chose to treat this one in this case. Cleaning and shaping of the canal revealed a curtain like canal anatomy with no distinct single canals. Canals like these are extremely challenging to debride.
The endodontic filling reflects the complexity of the anatomy and the merging of the multiple anastomoses to form the C shape.
Fortunately in this case the referring dentist allowed me to place the core material and the patient was referred over to their office immediately for preparation for Crown preparation immediately after the endodontics was completed. When treatment planning such cases, it is important to arrange for restoration of this tooth as soon as possible after the endo was completed. Our office coordinates appointments with the referring dentists when we suspect this is the case of hen we suspect deep fractures in the tooth we are treating. Leaving the case without adequate protection , (even with relief of the occlusion) can result in catastrophic fracture in as little as a few days.
Frequently, we schedule the Endodontics in the morning and the patient is immediately seen by the dentist that afternoon for Crown preparation an appropriate temporization. This kind of service requires cooperation from the referring office and good communication between Referral and Specialist.
Figure: Recurrent Decay
Recurrent decay contaminates previous treatment.
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Figure: Block Canal
Endodontic failure due to Blocked Canal.
