Interesting case: Fractured Tooth


I have a patient who was experiencing mild pain on chewing on one of his lower second molars. He is a grinder, but the first molar on that side shows most of the wear. There is no restoration (filling) on that tooth.  The tooth started bothering him to the point where he was losing sleepp, so I referred him to my endodontist ) root canal specialist) fur further evaluation.

The endodontist performed different test, such as chewing and ice, and a CT scan ontooth the tooth.

He was able to see that there was a fracture on the tooth that was  involving the nerve. His choices were an extraction or to have root canal therapy on the tooth. The problem with the root canal option is that the long-term prognosis of a fracture into the nerve on molars that have no fillings is guarded at best. For this case, the endodontist thought that, with a root canal and crown, that the would last 4-6 years.

The next question is whether this treatment is worth expense of a root canal and a crown with such a guarded prognosis. Ultimately this is up to the patient. However he could have an extraction and then have an implant and crown placed which will have a much better long term prognosis, or he can have an extraction and not get an implant. Not ideal, but still having a molar in the quadrant may still be provide enough chewing area for this patient.

This patient has some financial concerns, so the extraction is his choice, and he will see how he is doing after that to see if he would like an implant.

Here’s a bit more information on fractures. There are craze lines which are surface cracks only in the enamel which need no treatment. Patients can also fracture cusps which usually need an onlay or a crown to restore the missing part and protect the tooth. But when fractures get onto the root surface, that’s where problems can happen, including fracturing the tooth down the root. The prognosis of the tooth is then hopeless and must be extracted, and options to replace the tooth (implant, fixed bridge, removable partial denture) need to be explored.