I tried to repair fractures lines in furcation of lower molar treated endodontically years ago.... Any advice?
Thank you in advance and regrads.
In my point of view, to prevent the fracture of endodontically treated teeth, it should be covered with a crown. If there is fracture in the furcation, either root amputation or hemisectioning c
Dear Darwn,
Just that I was thinking but I want to know if there is some material or technique available less invasive.... Thank you very much, very useful your advice.
Depends on the position of the fracture. Furcation fractures are rare...and the idea of using some type of resection technique is totally dependent on many factors: apical position of the furcation, bone levels, root curvatures and the ability of the root to stand alone after a resection technique, occlusion, considerations of orthodontic root separation if it is a hemisection, forces on the tooth if only root resection (amputation) is performed, maxillary molar vs a mandibular molar, ability to create a good finish line and ferrule after the resection...there are many considerations and each case is unique. Crowning a tooth following root canal procedures in indicated in many cases but not all. Furthermore, crowning may not prevent a furcation fracture, as inherently there may be a weakness in a particular tooth's structure due to development...that is why we see so few of these. Also aberrant occlusal forces and parafunctional habits may contribute to these rare incidents.
Dear Professor Gutmann,
Certainly it was the cause of this fracture (aberrant occlusal forces). The patient was diagnostic with bruxism one year ago and he never treat it.... Very helpful your answer. Thank you very much...
i feel trying to restore fracture lines conservatively never works. You have to resect/ampute/split etc.. depending on the location of fracture line.
Dear Alain,
I have attempted to treat furcation fractures with and without hemisection and modified crown margins. For better adaptation in these critical areas, metal margins was successful done. Also crowns with fluted surface, for better maintenance was also attempted by me. Follow up cases of five and more years is available in my site. May be useful to check.
Pls check www.onlinedentallearning.com
Repairing furcation defects is very delicate, is better to analize first, if its more viable to do a hemisection of the crown or to remove one or another in order to preserve the one with better prognostic. Because repairing the furcation, in my opinion, it doesnt work for much time. It's better to do something more previsible even if its less conservative.
Generally, furcation fractures are not restorable and hemisection or root amputation generally over a long time span for molars are likely to fail due to the occlusal loads and parafunctional habits of the patient. Because of these, bone loss maybe more prevalent and preservation of the bone in extraction sites are paramount for restorative options. I am a conservative dentist and trained in both biomaterials and clinical research and have over 40 years in private practice, academics and military dentistry. As such the more viable option is to extract the root fractured tooth and to replace it with an implant and crown as the first option and a bridge the second option for restorations. Implants will have, in my opinion, the best long-term prognosis if correctly implanted and restored.
Seeing as how there are few if any documented cases or published articles on the incidence of furcation fractures, it would be unwise to resort to an immediate extraction in favor of an alternative treatment plan without examining the details and perspectives on each case. The skill and expertise of the clinician will also be a factor, and just "throwing in the towel" and going to extraction without doing an in depth assessment would not be advisable. For a perspective consider the following study: J Clin Periodontol. 1998 Mar;25(3):209-14. Long-term effects of root-resective therapy in furcation-involved molars. A 10-year longitudinal study. Carnevale G, Pontoriero R, di Febo G.
Totally agree. The examination on details of the patient before any treatment plan is very important to obtain resolts with better perspectives to patient.
Thank you all of you for all answer. Best regards.
Treatment planning is the key to success and I too agree with authors above.Also: I have successfully used MTA many times on furcation lesions and it does the magic. Best of luck !
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3514927/
http://www.ncbi.nlm.nih.gov/pubmed/17586038
Good choice Haroon...be creative and take all factors into account.