When re-restoring teeth, it is often necessary to decide whether an apparently vital tooth should be endodontically treated, or whether to correct an existing root filling surgically. Obviously, pulpless teeth, with or without periapical signs and symptoms of pathosis, must be treated.
Instances in which Elective Endodontic Therapy of an Apparently Vital Tooth may be Justified
Many of the radiographic signs are subtle and radiographs must be observed carefully for:
- Pulpal exposure.
- Very deep caries or very deep existing restorations (Fig 23-1a), particularly if associated with any of the factors below.
- Overprepared tooth stump (Fig 23-1b).
- Sclerosing pulp canals, if the sclerosis were to continue non-surgical endodontic treatment might be impossible (Fig 23-1c).
- Hypercementosis (although this can be idiopathic) plus: (i) very deep caries; (ii) very deep restoration; (iii) overprepared tooth stump (Fig 23-1a).
- Blushing during tooth preparation (Fig 23-1d) which fails to disappear within one week when dressed immediately with a steroid paste, for example, Ledermix (Lederle), for 10 minutes and then with zinc oxide eugenol cement. This recommendation is based upon the clinical records of 35 such teeth observed, on average, for nine years, with a range of four to 16 years. Only one of the teeth has developed endodontic problems. This recommendation requires verification by controlled animal study.
- Apical root resorption or indistinct root outline and: (i) deep caries, (ii) deep restoration, or (iii) overpreparation (Fig 23-1e).
- Radiographic loss of cortical plate continuity, including any of the indications listed above (Fig 23-1f).
- Periapical sclerosis including any of the indications listed above (Figs 23-1c, e).
- Internal/external root resorption (Fig 23-1g and Fig 4-27e).
- Tooth stump with insufficient retention or resistance form (Fig 23-1b). A post and core may be required for a mutilated tooth stump.
- Parallelism problems that cannot be overcome without the fabrication of a post and core.
- Furcation problems requiring root resection or division.
- Continued pain following tooth preparation.
Fig. 23-1 Indications for elective endodontics.