Vertical Root Fracture and Ethics

[Brause]

It is well known that most vertical root fractures occur in teeth weakened by previous endodontic procedures. It is also clear that such teeth have a poor prognosis and need to be extracted.

My very first experience with endodontics was a crack in the crown that demanded root canals in tooth 46. Two days after the pulpectomy, things went from bad to worse (history appears to repeat itself) with strong headaches and even worse toothaches. After a 3 month struggle I convinced the endodontist to have the tooth extracted, The endodontist took the attached exit X-ray and insisted to "finish the four root canals in 10 minutes" (for another $1000).

As you see, tooth 46 has a textbook vertical root fracture emanating from that calcium hydroxide fill. A classic Griffith crack forming at a stress point. My MSc thesis was at about microcracks in Quartz-Feldspar systems. Same thing. Here were are dealing with Calcium and Apatite.

I cannot prove when the crack formed: during the pulpectomy or thereafter, but from my symptoms, from the misery that followed the pulpectomy, the story is pretty clear.

Seriously, show me any dental publication with such a great image of a crack. And the endodontist even put the image in his letter to the surgeon writing him the tooth was not healing...duuuh!

P.S. The surgeon made a complete mess out of it, hammering for about 75 mins with a way too big burr on it. The periodontist performing the implant later commented "the bone is a battlefield". Somehow, 4 after the ex l the tooth 21 in the other thread became symptomatic....

...and, that special extraction treatment of the 4th quadrant caused neuropathic pain in tooth 41, which showed all the symptoms of an irreversible pulpitis including horrible headaches and toothaches, pulpal pressure, sensitivity to percussion, no sensitivity at all to 2 ends ice tests...BUT NO RADIOGRAPHIC ANOMALIES IN 1.5 years.

The endodondist wanted to drain me eveN more by sending me to another expensive "specialist", but my family physician stepped in and referred me to a neurologist, who is covered by the healthy system.

We then worked with Gabapentin, Carbamazepine, Amitriptylene, and Topirimate...

WHAT A CRAZY DOMINO EFFECT SINCE THE SUMMER OF 2023. I never had any dental problems before. I had not even heard of root canals, didn't know what that was.

 

[JcMac]

You should have just looked for a new dentist. You don't treat irreversible pulpitis by just taking analgesics, whatever the cause. You do need a root canal, or if that fails or you don't want it, extraction. Because both these treatments will remove the nerve, therefore completely resolving pain, much more effectively than any analgesics. (for which by the way no radiographic evidence is needed, the no sensitivity to the endo ice confirms irreversible pulpitis already)

You just had bad doctors and bad luck. Should have just switched doctors.

Because this is quite rare. Done by a specialist with a microscope the success rate of RCT is close to 100%.

I'm not a dentist but I think you should definitely get a root canal on every tooth where you have irreversible pulpitis. Because no other treatment will cure it, only relieve the pain, and probably not even that effectively. I would talk to a NEW endodontist about it.

Also that radiograph shows a tooth completely impacted onto another. don't know which teeth those are, but I also hope that you know that if they still are like that, they can't stay that way...