Restoratively speaking, as adult teeth progress through different stages of their life cycles (i.e., small filling, larger filling, inlay, onlay, crown, root canal treatment, post-core-crown replacement, etc.), they continue to lose integrity. At the end and after many years of hard work in a very harsh environment full of physical and chemical abuse, some are eventually lost. Among the many reasons cited in the literature for the extraction of endodontically-treated teeth, the most commonly reported are: large carious lesions, unrestorable teeth, followed by root fracture, periodontal disease and last of all endodontic disease.
Over-enlargment of the canal space and large instrumentation sizes
A very large access cavity and perforation
A conscious effort towards more conservative restorative and endodontic procedures will significantly contribute to the survival and retention of our precious natural dentition. Therefore, one of the most important goals in endodontic treatment should be: a more conservative access openings and instrumentation sizes. No restorative material is capable of replacing the lost natural tooth structure.
P.S. Respect the teeth and please stop using Gates Glidden or large round burs!
Heavy bite, specially with less than ideal occlusion or cusp-fossa relationship, can result in cracks and fractures in teeth. Here is an example of a case with heavy occlusal pressure concentrated on the lingual inclinations of the buccal and lingual cusps of tooth #2-4. Two mesial enamel cracks are evident in this case.
Lets imagine the following scenario if we do nothing for this asymptomatic tooth:
With time, the cracks propagate and involve the pulp chamber. Based on the position of the existing restoration, a tooth split may result no matter how innocent (don’t blame the amalgam fillings). Clinical symptoms (pulpitis) appear. Root canal is done and the initial sensitivity symptoms do resolve. A crown is then fabricated for a possibly deeply cracked tooth. The biting tenderness however persists post-endodontic treatment. If the patient is lucky not to go through further unnecessary treatments (i.e. retreatment, apical surgery, etc.), the tooth will eventually be replaced with an implant. And, this is one of the reasons why root canals get their poor reputation. “Root canals don’t work”, “every root canaled tooth fractures”, or the most insulting to my profession that I have ever heard: “root canaled tooth is an eventual space maintainer for an implant.”
So, lets contemplate the above scenario and think about prevention and saving teeth instead.
Office website: vanendo , FaceBook page: @endospecialists