Cracked Tooth Syndrome: Root Canal Treatment Challenges

During root canal treatment, a crack in the tooth root was discovered?

Hello Doctor, last month I began root canal treatment on my lower left first molar due to decay.
During the second visit, the doctor mentioned the possibility of a root fracture.
By the third treatment, any attempt to insert a needle or inject medication would cause bleeding.
Even during the fourth treatment, there was still intense pain and bleeding when injecting the medication.
The doctor informed me that the root may indeed be fractured, and due to the continuous bleeding, it is impossible to thoroughly disinfect and fill the root canal.
Therefore, the doctor does not recommend keeping the tooth, but since it is the first molar, I would need an implant after extraction.
I would like to ask if such a situation can occur, as the X-rays do not show any signs of a root fracture.
Is there any current medical method to further confirm this, or is it truly as my dentist said that this tooth cannot be saved? Additionally, I would like to inquire about the temporary situation; since I have other teeth undergoing treatment, I do not plan to extract it immediately.
The dentist has placed gauze and some temporary filling material in this molar; how long can this situation last? If the tooth is indeed extracted, how soon is it safe to proceed with the implant? Thank you for your response, Doctor.

C, 20~29 year old female. Ask Date: 2016/04/25

Dr. Zeng Guanghui reply Dentistry

The lower left first molar has undergone root canal treatment due to caries, but bleeding occurs during needle insertion or injection, indicating that there may be a perforation or crack in the root.
If the crack is longitudinal and has affected the periodontal ligament, the tooth is likely to experience recurrent infections in the future, and extraction is recommended.
If the tooth is extracted without any apical or periodontal infection and the thickness or height of the alveolar bone is sufficient, immediate implant placement can be considered.
However, if the condition of the alveolar bone is poor or there is an existing periodontal infection, it is advisable to wait 3 to 6 months for the wound to heal before proceeding with implant placement.

Reply Date: 2016/04/25

More Info

Cracked Tooth Syndrome (CTS) is a complex dental condition that can pose significant challenges during root canal treatment. Your situation, where the left lower first molar has shown signs of potential root fracture, is not uncommon. The symptoms you describe—bleeding during treatment, severe pain upon injection, and the dentist's concerns about the integrity of the tooth—are indicative of a serious issue that may necessitate extraction.

Understanding Cracked Tooth Syndrome
Cracked Tooth Syndrome occurs when a tooth has a crack that is not visible on X-rays but can cause significant discomfort and complications. The cracks can extend into the pulp of the tooth, leading to inflammation and infection, which complicates root canal treatment. In your case, the bleeding and pain during the procedure suggest that the crack may have compromised the tooth's structure, making it difficult to effectively clean and fill the root canal.

Diagnosis and Confirmation
While X-rays are a valuable tool in diagnosing dental issues, they may not always reveal cracks, especially if they are small or located beneath the gum line. Dentists often rely on clinical signs and symptoms, as well as patient history, to make a diagnosis. Advanced imaging techniques, such as cone-beam computed tomography (CBCT), can provide a more detailed view of the tooth and surrounding structures, potentially revealing cracks that standard X-rays miss. If your dentist suspects a fracture, they may refer you to a specialist for further evaluation.

Treatment Options
If the tooth is indeed cracked and cannot be saved, extraction may be the best option. The first molar plays a crucial role in chewing and maintaining the alignment of your teeth, so replacing it with an implant is advisable. Generally, after extraction, it is recommended to wait a few months for the bone to heal before placing an implant. However, some dentists offer immediate implant placement, depending on the condition of the extraction site and the overall health of the patient.

Temporary Measures
Regarding your current situation, with the tooth being temporarily filled and packed with gauze, this is a common practice to manage pain and prevent further infection while you decide on the next steps. The duration that this temporary solution can last varies, but it is typically a short-term fix. You should monitor for any signs of increased pain, swelling, or infection, and communicate these to your dentist promptly.

Conclusion
In summary, your symptoms and the dentist's observations suggest that the tooth may not be salvageable. While it is essential to explore all options, including advanced imaging, the likelihood of needing an extraction seems high. If extraction is necessary, planning for an implant soon after healing is crucial for maintaining oral function and aesthetics. Always ensure to have open communication with your dental care provider about your concerns and treatment options, as they can guide you through this challenging situation.

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