Does 208 need to be extracted? There is some periapical lucency around the caudal root of 208 and it has a slab fracture but unable to get probe into pulp cavity and probing depth of the tooth was normal. 209 has been extracted.

RE: Does 208 need to be extracted? There is some periapical lucency around the caudal root of 208 and it has a slab fracture but unable to get probe into pulp cavity and probing depth of the tooth was normal. 209 has been extracted.

Stumpy — Thu, 21 Jan 2021 22:09:28 GMT

Thank you for your advice

RE: Does 208 need to be extracted? There is some periapical lucency around the caudal root of 208 and it has a slab fracture but unable to get probe into pulp cavity and probing depth of the tooth was normal. 209 has been extracted.

Stumpy — Thu, 21 Jan 2021 22:09:04 GMT

Thank you very much. Yes 207 probed normally.

RE: Does 208 need to be extracted? There is some periapical lucency around the caudal root of 208 and it has a slab fracture but unable to get probe into pulp cavity and probing depth of the tooth was normal. 209 has been extracted.

Norman Johnston — Thu, 21 Jan 2021 19:05:30 GMT

I agree with EBH.
a good rule of thumb re success is how much loss of width the slab fracture causes. If it’s approaching 50% the tooth might well fracture again if root filled because of the huge forces on the carnassials. Crowning in addition can add strength but doubles the cost roughly- and it’s still a weak tooth underneath

RE: Does 208 need to be extracted? There is some periapical lucency around the caudal root of 208 and it has a slab fracture but unable to get probe into pulp cavity and probing depth of the tooth was normal. 209 has been extracted.

Evelyn Barbour-Hill — Thu, 21 Jan 2021 17:54:15 GMT

Clearly there is endodontic disease. There is periapical lucency and the apex looks mildly mis-shapen. Yes, it needs treating. Endodontic treatment ("a root canal") should be successful. If the edge of the fracture goes well below the gum line it's a bit tricky to recreate a contour to restore a normal gum-tooth seal, but it can be done.

If endodontic treatment is not possible, then yes, it must be extracted. Or another view might be that if 209 is already gone, it would be no great loss if 208 went. Otherwise there will be pain for a long time terminated only by the good fortune of abscess development, which will of course demand extraction anyway.

Whether a probe can be got into the pulp cavity is a very poor guide – no guide at all really. I've never known a slab fracture on an upper 8 not expose the pulp. Sometimes the opening gets blocked with some sort of concretion, but it's still a pulp exposure. And even if the pulp were not quite exposed, the exposure of tubules through thin remaining dentine can also lead to pulpitis

Incidentally, there's bone loss on the distal of 207. This needs to be addressed even if you don't apply any particular treatment.What does that site look like? Is it probe-able?

Oh, and a lovely example of the extra root that is sometimes found on the upper 7s.