Page 18 - The Beauty and Sorrow in Endodontics (Chapter 4 - Part 2)

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12-years ago – Tooth 17 presented with cracked tooth syndrome. An ortho band
was applied at that time with subsequent endodontic treatment and crown

coverage (Fig 46C). The patient has been asymptomatic since.
10-years ago – The patient presented with extreme pain on tooth 27 and a
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cracked tooth was suspected. Endodontic treatment was completed first for
pain relief (Fig 46D). However, the patient failed to return for crown

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coverage for tooth 27 due to his busy work schedule, and the tooth had
fractured less than a year after root canal treatment completion and was then
extraction (Fig 46E).

3-weeks ago – The patient presented for endodontic consultation due to pain on
biting on the right side. The referring dentist suspected cracked tooth

syndrome on 16, however, no visible crack line was observed clinically
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(Fig 46F). A temporary crown had been placed on the tooth for cuspal

protection first.

A few days ago – The patient presented to the referring dentist’s office reporting
of spontaneous pain in the top right region and he had since avoided

chewing on the right side completely. The referring dentist expressed
concerns with the difficulty of implant placement in the 16 region due to its
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proximity to the sinus (Fig 46G) and the amount of bone loss present (Fig

46H).
HCC: The patient reported history of sensitivity on the right side to biting and hot

and cold stimuli, and ever since the referring dentist had placed the temporary
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crown on 16, he has been slowly starting to chew on the right side. However,
starting a few days ago, he has been experiencing throbbing pain at night-time.

O E/O: TMJ and muscles of mastication are WNL
I/O: Overall fair oral hygiene (Fig 46I)

# 16 STP (slight +), PD 3-4mm, Cold (++)
Rad (Fig 46G, 46H): No periapical radiolucency

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A Dx: 16
Pulpal: Irreversible pulpitis
Periapical: Symptomatic apical periodontitis

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