Irreversible Pulpitis from Bruxism/Trauma: Prognosis?

Joined
Dec 26, 2023
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Peer-reviewed literature typically assigns reversible pulpits to caries...with nice tooth diagrams. The end product is an apical abscess from bacteria harboured in the root.

As rarer causes, bruxism/trauma are mentioned as the cause, but no details are given.

The question is: how do bacteria enter the root canal without caries? Answer: through microfractures that may develop over time.

Imaging small fractures is difficult to impossible so that the clinician relies on a line of evidence (bite test, palpation, percussion test etc.) for a predictive diagnosis.

The first step is typically root canal treatment: "wait and see..."

The question is: if there is no caries, doesn't there have to be a root fracture to cause irreversible pulpitis/apical abscess? And if so, isn't a negative outcome of root canal treatment pre-determined in such case?

In other words: apical abscess without caries...shouldn't the tooth be extracted right away without bothering with RCT?

What would justify RCT in this case?
 

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