Irreversible Pulpitis from Trauma?

[Brause]

Literature describes pulpitis as a progress from reversible to irreversible, caused by caries...or, rarer, by cracks or vertical root fractures.

But irreversible pulpitics can also be caused mechanically by trauma (from occlusion, bruxism etc.), without an obvious pathway for bacteria.

How is this possible? How does this process work?

 

[Dr M]

If you think about it, processes such as grinding, does in fact lead to the formation of micro fractures, which could facilitate the formation of a pathway for bacteria to follow. This process happens over time and is not an acute type of event.

 

[Brause]

But how should RCT fix this as these micro fractures remain. Wouldn't it be indicated to extract a tooth in such a case (without bothering with RCT)?

 

[Dr M]

A root canal is never supposed to be a long term solution. I always explain it to my patients, that the indicated tooth is on its way out, and the only way to try and keep it in the mouth for a while longer, is to perform a root canal. Although the lifetimes of root canals differ, depending on a host of factors, they all eventually fail, since even our disinfectant capabilities, has not reached its pinnacle yet.

 

[Brause]

I talked a lot with friends about their root canal experiences...only 2 of them reported long-term success.

So far none of my 2 teeth receiving RCT showed any signs of improvement...not for a day even.

My gut feeling told me from minute one to skip RCT and go for extraction. But then again, an implant does not have ligaments, which have a function...and implants probably can also provide problems.

 

[Brause]

As to apicoectomy...absolutely not. Very low success rate.

 

[Dr M]

Even though an implant does not have all the same functions as a normal tooth, it is still currently the best alternative we have compared to your natural dentition.