Endodontics · patient case question
The premolar looks like a root tip clinically but has an intact root, patent canal, and good bone support. What is the MOST appropriate treatment?
Patient case: 84-year-old with a heavily restored dentition
Patient: 84-year-old man, first visit in several years.
Chief complaint: Wants his mouth checked over.
History: Medically stable, independent, no bisphosphonates, no radiotherapy. Good manual dexterity.
Findings: Radiographs show amalgam restorations in nearly all posterior teeth. On one posterior molar roughly half the coronal tooth appears absent with a clean cavity outline. A premolar looks clinically like a retained root, but radiographically the root is intact, the canal is patent, and bone support is good. A third tooth has an established periapical infection.
Show answer and explanation
Correct answer: C. Root canal treatment, core build-up, post, and crown
- A. Extracting a restorable tooth to place an implant is more invasive, more expensive, and discards healthy bone-supported root structure for no clinical gain.
- B. A post cannot be placed in a vital or untreated canal. Endodontic treatment must come first.
- C. CORRECT. Sound root structure with adequate bone support in a patient with good dexterity is worth saving. The sequence is endodontic treatment first, then a foundation restoration, then a post ONLY if insufficient coronal structure remains to retain the core, then a crown with an adequate ferrule.
- D. A crown needs something to sit on. With most of the coronal tooth gone, there is no retention or ferrule without a core.