End of Day Cases 3 (EDC) Cracked premolar! - part 4

Allen Ali Nasseh   uploaded 1 year ago

Discussion of risk and benefits and prognosis are challenging aspects of care. Dr. Nasseh discusses today’s patient and the discussion about extraction or saving the tooth. Participate in the discussion.

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    • #3019
      AvatarHenry Chung

      I have a patient with a cracked #13(Virgin) with normal pulp testing but pain on percussion and biting. I placed a temporary crown and had the patient come back in 3 weeks. When he came back, the tooth was normal on percussion but slight pain to biting. What should I do?

    • #3020
      Allen Ali NassehAllen Ali Nasseh

      @Henry Chung: Well, these are the reasons why cracked teeth are a problem. It’s the uncertainty of it all. Although 3 weeks is not nearly long enough. You should definitely wait at least 8 weeks to wee what’s going on. At that point if there’s still symptoms to bite I would just explain to the patient the options of taking a risk and restoring vs. calling it quits and extracting. This is part of the risk management aspect of treating cracked teeth. Good luck!

    • #3041
      AvatarIdi S

      At the 2m mark im positive this twooth will be asymptomatic. post anc core and maybe release it from lateral forces. m sure this tooth will last for a long time

      • This reply was modified 1 year, 4 months ago by AvatarIdi S.
    • #3045
      AvatarHenry Chung

      When he came back a month later for the final crown, he still had pain on biting and did not have thermal sensitivity. I felt that Pulp is normal but patient and I decided to do RCT and deliver the final crown. When I accessed the tooth, I can see the crack line extending into the access. I remember an Endo textbook by Torabinejad Endodontics Principles and Practice stating that cracked teeth should have wedging forces applied but it appears not all endodontist and general dentists practice this way. What are your thoughts Dr. Nasseh?
      Also I have another cracked molar case where the RCT did not get rid of the symptoms to biting pain at two weeks later after RCT/delivery of final crown.

    • #3050
      Allen Ali NassehAllen Ali Nasseh

      @Henry Chung: Well, these are some of the reasons why cracked teeth are frustrating. You sacrifice predictability of optimal outcomes for an attempt at saving the tooth. Unless the patient is very clear about this it can lead to frustrated patients and loss of confidence. BTW, you can upload your x-ray of the case by adding an attachment to your reply. Persistence of symptoms after endo in a molar may be due to the crack but may be to a number of other possibilities as well. It’s hard to presume without seeing a post operative radiograph.

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