Ten or fifteen years ago, a tooth like this would probably be treated
with a root canal and a crown.  This will *probably* save the tooth
for a number of years (5-25 depending on how severe the fracture).

Now, with the advent of single tooth implants, it could be argued that
the best choice is to quit 'attempting' treatment on a problem tooth.
An extraction and subsequent implant is a reliable long term alternative
and may actually be more cost effective in the long run.

Fawks

Ok ove just been looking up info on cracked tooth syndrome.  Just read
this part "Cracked tooth syndrome is a very common problem that
affects teeth that have large fillings in them.  Decay and large
fillings causes a weakening in the remaining tooth structure over
time."

It says over time but can it happen immediately  after the filling is
done or during it?  The pain on release of pressure on the tooth only
began when he had done the filling and i first noticed it about an
hour after it was done which is when i first tried to eat after the
numbing stuff had worn off.   So is it possible for the tooth to crack
while the filling is being done?  There was zero pain in the tooth
before the filling.

W_B <no_one@nowhere.net> wrote:>

How come nobody is mentioning what may happen to the periodontium if
this crack progresses? I would think that is one of the worst dangers of
not getting the crack reinforced with a crown right NOW, or if that
doesn't completely do the job. I would say he should be fitted with an
ortho band  and re-fill the tooth with Fuji 9 and see if it settles
down. If it does, proceed to RCT and reinforcing crown. The caveat
empror is that the crack may still progress and undermine the bony
attachment causing a vertical pocket.

I would say it is well to remember that this is a lower first molar with
(as yet) good bone support. Why did it break? Probably clenching.
Therefore, his other teeth are at as much risk as this one, and probably
the lower left first molar is at heightened risk, as the forces shift
over there by reflex. Therefore, James needs protection for the
remaining dentition:

===============>James needs an NTI<===================

Some of you just _may_ have heard of this little device.   ;-)

So, I would say this:

1) Ortho band and NTI right away.

if symotoms abate:

2) RCT, crown (I would make an all gold, SM would do a CEREC w/o glaze.
3) Frequent recall for the periodontal response, and if pocketing or
unexplained inflammation ensues, get the tooth OUT.

4) Which could mean, I *think*, that we are in an implant situation
in... what? Five or ten years?

So the choice is whether or not James wants to halt investment in this
tooth now or later.

I don't suppose anybody else would consider using a Stainless Steel
Crown cemented with Fuji 9 as a temporary measure? I might try that as a
reinforcement for the Endo, which in my own humble hands, would surely
take more than one appointment.

Thank You

<The Pipe puts his lollypop back in his mouth>
SP