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Medical Forum / General / Dentistry / January 2009

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Possible root fracture: how long can I wait?

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agerla1965@gmail.com - 25 Jan 2009 23:59 GMT
Hi everyone,

One of my upper medial incisors has had 3 or 4 endontic procedures on
it, including an apicoectomy (following a large fistula), and has been
crowned for 26 years.  The tooth has not been vital for 34 years.

Like an idiot, I was ripping a tough pummelo membrane with my teeth,
sort of sideways, when I heard and felt a "crack!"  Felt like a little
thump by the alveolar ridge.

That was maybe 5 days ago.  I have since confirmed that the tooth is
slightly more mobile and cracks when I scrape an artichoke leaf of
otherwise bite on the tooth. (yes, I have stopped doing that!)  Today
it has begun to feel a little abnormal somehow.  No pain, just vaguely
uncomfortable.

My first thought was that the crown cement integrity is gone.  But my
hunch is a root fracture.  I need to wait a week or two before going
to the dentist if I can.  Is it ok to do that, absent any overt signs
of infection?

Also, the tooth had a periapical abscess for a period of two years or
so.  It would come to head every few months and then blow (vile!!!),
reseal, then slowly fill up with pus again.  My mother gave me
poultices but it never occurred to her to take me to the dentist.
Odd, eh?  Anyhow, the surgeon said it was the size of a walnut, and
after scraping and an apicoectomy, the tooth was quite mobile for a
time.  Frankly, I am surprise that this tooth lasted at all.  Because
of the abscess and scarring, could there be any problem with an
implant?

Thanks,

Beth the pummelo eater
Steven Bornfeld - 26 Jan 2009 00:31 GMT
> Hi everyone,
>
[quoted text clipped - 30 lines]
>
> Beth the pummelo eater

    It is also quite possible that if there is a post it has loosened up in
the canal.  Yes, it could be fractured, but usually in an
endodontically-treated tooth you would have pain when luxating (trying
to move) back and forth, as the fracture tears into the periodontal
membrane.
    I'd get it checked promptly.  Best case scenario--the crown can be
recemented (I wouldn't bet the farm).  Worst case--tooth is lost.  This
is generally an easy area to graft if there is insufficient bone, so
it's likely you can still get an implant despite the history, in the
event the tooth has to come out.

Steve
agerla1965@gmail.com - 26 Jan 2009 02:09 GMT
On Jan 25, 6:31 pm, Steven Bornfeld <dentaltwinm...@earthlink.net>
wrote:
> agerla1...@gmail.com wrote:
> > Hi everyone,
[quoted text clipped - 44 lines]
>
> Steve

Steve,

Thanks for taking time to give some possibilities.  There is no post
in there.  I rather suspect that the itchy discomfort that seemed to
refer to the floor of one nostril is the kind of periodontal
irritation you refer to.  Hoping no graft would be needed, as my
insurance mostly likely does not cover an implant, much less a graft.

Beth
 
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