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Endodontics · single question

A patient presents with deep, subgingival caries causing lingering pain (around 20 minutes) after a cold stimulus, with extensive coronal destruction. What is the most appropriate treatment?

  1. Extraction, given the combination of extensive coronal destruction and subgingival extent significantly compromising long-term restorability and prognosis
  2. Root canal therapy and crown, regardless of the extent of destruction or subgingival involvement
  3. No treatment is needed since the pain will likely resolve on its own
  4. Antibiotics alone, with no further dental intervention
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Correct answer: A. Extraction, given the combination of extensive coronal destruction and subgingival extent significantly compromising long-term restorability and prognosis

The combination here — symptomatic irreversible pulpitis-type lingering pain PLUS extensive coronal destruction PLUS subgingival caries extension — significantly worsens long-term restorability and prognosis, since adequate ferrule, isolation, and a predictable margin become very difficult to achieve. In such cases, extraction (followed by appropriate replacement planning) is often the more predictable, evidence-based choice over attempting heroic restorative/endodontic salvage of a tooth with a poor long-term prognosis.

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