Small vertical crack

Sir, I would like to draw the readers' attention to an interesting case which I encountered on a patient recently. A fit and healthy 47-year-old lady presented to me as an emergency, complaining of a constant throbbing toothache with intermittent 'electric shocks' from the lower right side, which painkillers were not even 'touching'. She began to experience these symptoms after biting on something and presented to the clinic after three days.

Upon clinical examination, the lower right seven, which had a small occlusal amalgam, was very tender to percussion and was positive to vitality testing. There was a small vertical crack running in the disto-lingual aspect of the tooth. A periapical radiograph was taken and is shown here (Fig. 1).

Figure 1

Periapical radiograph

The lower right eight is impacted under the lower right seven, causing root resorption. There is loss of the lamina dura and therefore potential hindrance of the cushioning effects of the periodontal ligament. The lower right six is heavily restored, with radiolucencies associated with the distal root, and under the crown (likely radiolucent cement).

The prognosis of the lower right seven was poor, and after a full discussion with the patient it was decided that the best option was extraction.

As can be seen (Fig. 2), the vertical fracture has propogated down the length of the tooth. This may be attributed to the impacted eight and subsequent loss of the cushioning effect of the periodontal ligament.

Figure 2

Vertical fracture down the length of the tooth