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A J shaped lesion is not pathognomonic of VRF

February 28, 2016 By Dr Pierre Pizem 2 Comments

47 endodontic revision j shape pre therapy 47 endodontic revision j shape post therapy

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.

Filed Under: Post endodontic treatment outcomes, Regeneration of the periradicular tissues, What's new? Tagged With: dental implant, endodontic procedure, endodontic revision, extraction, root canal procedure, Root canal treatment, root canal revision, j shape lesion, vertical root fracture, experts

Reader Interactions

Comments

  1. Dr.Abhay Shukla says

    February 29, 2016 at 3:33 am

    This is a great case doctor. And thanks a lot for sharing. Actually i was so into the myth that j shaped lesion is the sign of VRF.. you took me out of it.
    Regards
    From India

    Reply
    • Dr Pierre Pizem says

      March 15, 2016 at 3:45 pm

      Thank you Dr Abhay Shukla. Glad you liked it

      Reply

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