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First Molar Calcified – Wait too long for root canal therapy?

Price: $805.

This new patient in her 40′s presented with a complaint of transient pain upon chewing. No complaint of temperature sensitivity.

Our test results were delayed cold response with tenderness to percussion and tooth slooth tender on the mesio-buccal cusp.

Radiographically, in relation to the pulpal chamber there was a deep restoration with what appeared to be a base. Another dentist placed this years ago. Most of the mesial portion of the canal appeared severely calcified.

Diagnosis: Irreversible inflammation of the pulp (it’s dying). Partial pulpal necrosis. Possibility of a crack associated with it and the large restoration.

Endo

Challenge: calcification of the mesio-buccal pulpal canals, morphology of the pulpal chamber

Treatment:  Revealed only one mesio-buccal canal. No visible crack extending into the pulp chamber or throughout the walls

Prognosis: Guarded, dependent on timely restoration

1st molar endo

Should this root canal have been performed prior to symptoms?  Should deep restorations like this be placed with a heightened risk of pulpitis?

Short answer:  Yes and Yes. Root canals should be recommended for all teeth with deep restorations like this. Root canal therapy is more predictable and there’s less risk in losing the tooth if the tooth is treated asymptomatically.  This is a predictable situation. However, deep restorations are helpful for short-term treatment but should be accented by the recommendation of a root canal in the future.

Follow-up question:  Could the pulp have been better protected by an onlay or crown?  Would the tooth have needed a root canal if a crown or onlay been placed instead of a deep direct restoration?

Answer:  Yes and not sure, it’s patient dependent. However, lower incidences of pulpitis are found with teeth which have been crowned earlier in life.