Case 23 When a fracture is not a fracture, tooth #18

Pre-operative x-ray


Necrotic tooth with periapical lesions



Photo of access opening with fracture circled in red







Please note: fracture line down distal
Immediate post-operative x-ray





6 month post-operative x-ray



Periapical radiolucencies are gone






Comment:
When fractures are noted, careful probing of the pockets in the area of the fracture line is needed.  Many times a good periapical x-rays will show bone loss which will indicate a non-restorable tooth. Patients need to be informed of fractures and the possibility of eventual tooth loss if one does exist. However, in my experience, teeth that are periodontally sound after initital root canal treatment and immediate full coverage tend to remain so.