Recent RCT: From no pain to pain after biting down hard

Discussion in 'Endodontics' started by Christoph, Apr 5, 2018.

  1. Christoph

    Christoph

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    A few weeks ago, my molar #14 cracked (or an existing crack worsened). That tooth had a 3y old keyshaped Amalgam filling, which had replaced a much smaller composite filling on the side of the tooth. It started with pain while chewing, then progressed to constant pain. My dentist prepared the tooth for a crown and put on a temporary crown. No abscess could be seen on the xray so the idea was to see whether the inflamed pulp would settle down to avoid an RCT.
    Unfortunately, the pain continued and got worse so I was referred to the endodontist who spotted a narrow crack extending below the gum line on the CT scan. He said there was an abscess but it was in the early stages so it wasn’t recognizable on my dentist’s xrays. My choice was to remove the tooth plus implant, or see if an RCT plus crown would suffice to “hold the tooth together “. Due to the high cost of the implant I took my chances with a crown. After drilling and filling with guttapercha, the Dr said he didn’t see the crack from within the tooth, which gave me some hope.
    Within 48h after first of three RCT sessions I was virtually painfree and could chew again on that side with say 3/4 of chewing force and a bit slower and more careful than usual since I still have a temporary crown pending two more RCT sessions.
    The RCT was one week ago. Three days ago I accidentally bit down on something hard and there was instant pain in the tooth. Not sharp “inside” the tooth but more in the jaw. After that, biting down even lightly on something, hurt quite a lot. Now three days later it has gotten ~50% better but it is still a lot worse when chewing than 48h after the initial treatment.
    Note that the pain is worst when biting down, not when releasing. Also, I don’t have pain when not chewing. Can you think of any explanation other than an increase in the detected crack that could lead to such a long-term increase in sensitivity? I’ll be going back to the Dr in 1-2 days but would love to hear some opinions before that. For obvious reasons I’m very concerned that the tooth must be removed. Thank you!
     
    Christoph, Apr 5, 2018
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  2. Christoph

    Busybee

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    Christoph it's not common for a dentist to try to save a tooth that has a crack below the gum line. Perhaps you just need the dentist to adjust it as may be too high given it's not so strong. If you still have a temp crown on then you should be really careful how you chew on that side. Once a permanent crown is on you should have more of an idea of whether it's successful.
     
    Last edited: Apr 5, 2018
    Busybee, Apr 5, 2018
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  3. Christoph

    rctdoc

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    Christoph,
    As a practicing endodontist, and one with a CT scanner, I can tell you that detecting a fracture on a CT scan or any radiograph is very difficult unless the fracture is so extensive that the tooth is not able to be saved. Checking the probing depths of pockets adjacent to a suspected fracture would be important, however these deep probings only occur after some time has passed after the fracture. My experience in detecting fractures using a narrow beam CT scanner is, that I had a patient who had a tooth where I could visually see a fracture through a microscope. I asked him to take a CT scan of the area just to see if the fracture would be seen radiographically, and it was not! Therefore I do not rely on the CT scan to show me a fracture line, instead we look to see how the pattern of bone loss next to the area of interest is. Fractures really are very hard to anticipate, sometimes it is clearly visible that a fracture is devastating, but oftentimes it is not known for sure whether they will lead to loss of a tooth. Therefore it is important for a patient to understand and let him/her decide whether to try and save a tooth or not.
     
    rctdoc, May 4, 2018
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  4. Christoph

    Busybee

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    What about MRI rctdoc?
     
    Busybee, May 4, 2018
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