Page 26 - The Beauty and Sorrow in Endodontics (Chapter 4 - Part 2)

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S Age/Gender: 40 F
CC: Consultation for 27 crack
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HCC: The patient reported history of food trap and discomfort on the upper left
posterior region when eating. She reported biting on chicken bone one day

and has since been experiencing occasional throbbing pain. Her husband, a
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dentist, had completed a large restoration for her on 26 and saw crack lines
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on 27 during caries removal, so he had placed IRM temporary restoration
for the meantime and brought her to the clinic for endodontic consultation
prior to crown placement.

O I/O: 26 MOD composite resin
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# 27MO composite resin, STP (+), APT (+), MB/DL PD 4-5mm

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# 18, 28 partially erupted
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Rad (Fig 47A): 27 widened PDL
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A Dx: 27
Pulpal: Necrosis
Periapical: Symptomatic apical periodontitis

Etiology: Cracked tooth from parafunction?

P Discussed proposed treatment plan with the patient and her husband. Informed
consent obtained to proceed. The patient was aware that endodontic treatment will

relieve the discomfort, however, the crack may progress and she may still need to
have the tooth extracted in the future.

1) 27 Root canal treatment and assess extent of crack
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Local anaesthetics given. Rubber dam isolation. Microscopic examination

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showed multiple crack lines on the coronal tooth structure of 27 along with
evidence of attrition on the cusp tips (Fig 47B). Access cavity prep showed clear

crack lines approaching the pulp chamber (Fig 47C, 47D). The crack across the

pulpal roof connected to the mesiobuccal crack (Fig 47E), and there were no
signs of bleeding after the pulp chamber had been accessed, which confirmed

pulpal necrosis (Fig 47F). Cleaning and shaping utilizing the EOM completed
and a master cone fit radiograph was taken (Fig 47G). During the whole

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