Not all cracked teeth must be extracted
The infamous “J-shaped lesion”
This PA and CBCT scan showed a “J-shaped lesion.” However upon closer review, there is definitive spicule of bone attached to the distal CEJ
This is an endo-perio lesion; this is not a cracked tooth despite the radiographic presentation.
This patient’s furcal lucency as well as this “J-shaped” PA lucency DOES NOT – ever – mean that a tooth is unrestorable, even though many would think it so, unfortunately!
Perio pocket probing in addition to the other pulp vitality tests and most especially the #cbct will show suggestive/clear fractures within a #tooth and restorablility
While this case DOES HAVE a J-shaped lesion, because of CBCT imaging we can definitely know that it is a primary endo lesion and the path of least resistance happens to be along the D periodontal pocket; this is not a fracture! This is secondary
This will hopefully heal/should heal after #endodontic treatment
In other words, treating the endo, will resolve the periodontial pocket #endoperio as well as the PARLs
Two weeks after I medicated, I completed the case.
I didn’t ever see the separated instrument come out, I truly believe I bypassed it but I am pleased with the final #periapical film and hopefully this patient will return in 1 yr with a new crown as well as full bony healing.
In the above case, a few months later, one can appreciate the great bony healing that has resulted after the endo!
Endodontics – root canals – save teeth!!!
Please remember, *NOT* all J-shaped lesions are fractures, but ALL fractures usually show J-shaped lesions