Endodontics · single question
Same case. What is the correct treatment sequence for a tooth with pulpal necrosis after complex fracture extending subgingivally?
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Correct answer: C. Root canal treatment → post and core → crown lengthening → crown
The correct treatment sequence for a fractured necrotic tooth with subgingival extension is: (1) ROOT CANAL TREATMENT first — to address the infection/necrosis and prevent further contamination; (2) POST AND CORE — to build up the coronal structure after RCT; (3) CROWN LENGTHENING — to expose adequate tooth structure (ferrule) for crown retention, after the root canal is done to avoid re-contamination; (4) CROWN — final restoration after healing from crown lengthening. RCT must come first to eliminate infection before performing surgical procedures.
- A. INCORRECT. Placing a post and core BEFORE root canal treatment would be impossible — you need to first complete the RCT (clean and fill the canal) before placing a post into the obturated canal.
- B. INCORRECT. Crown lengthening BEFORE root canal treatment creates surgical access but risks contamination of the open apex during the surgical procedure. RCT should precede crown lengthening.
- C. CORRECT. RCT first eliminates infection → post/core restores coronal structure → crown lengthening exposes adequate ferrule → crown provides final seal and protection.