On July the 29th 2009, we have been presented with this mandibular second molar. Patient was experiencing pain. This radiographic image showed a huge radiographic J-shaped lesion in the mesial aspect of the mesial root. Back then, according to some experts, this type of lesion along with a deep narrow probing was considered as a pathognomonic sign of a vertical root fracture. Since vertical root fracture has a hopeless prognosis, standards of care would have commanded its extraction. In the presence of such a periradicular tissues loss, extraction would have also been indicated in the event we were dealing with a periodontal infection.
Still, what if we were dealing we an endodontic infection? If this was the case, an endodontic revision (endodontic retreatment) would suffice to preserve this tooth. The decision of extracting or saving that tooth has been based on a foundation of sound diagnosis, as we opened the existing PFM crown to confirm the presence of a crack which we could not find.
An endodontic revision which implied an interim calcium hydroxide has proven to be the correct approach, no dental implant needed here.