Introduction.
A 33-year-old patient presented to our dental clinic with a chief complaint of pain and swelling in the lower left back tooth region. The discomfort had intensified over the past few days and was now associated with difficulty in chewing and a constant dull ache radiating to the jaw.
Upon clinical and radiographic evaluation, a complicated molar fracture was detected leading to a necessary discussion of treatment options, including extraction followed by implant placement or a fixed dental bridge.
Clinical Presentation.
Symptoms:
- Persistent, dull pain in the lower left molar region (tooth #36 or #37)
- Swelling in the buccal vestibule
- Occasional sharp pain on biting
- Mild mobility and tenderness on percussion
Clinical Findings:
- Deep periodontal pocket
- Buccal swelling with localized tenderness
- Possible sinus tract near the affected tooth
Radiographic & CBCT Analysis.
Radiographs and CBCT findings:
- Periapical radiolucency indicating chronic infection
- Bucco-lingual fracture line visible on CBCT scan
- Fracture extending from the occlusal surface down to the CEJ
- Loss of lamina dura and sclerotic changes in periapical bone
- Evidence of bone loss around the roots
Diagnosis.
Final diagnosis:
- Vertically fractured lower left molar with chronic periapical infection and associated buccal swelling.
- Non-restorable due to fracture extension to the CEJ and compromised periodontal support.
Treatment Plan.
Given the extent of the fracture and the poor prognosis for root canal retreatment or restoration, extraction was advised as the primary course of action.
Option 1: Dental Implant (Preferred).
- Extraction with ridge preservation
- Implant placement after 8–12 weeks of healing
- Final crown placement after osseointegrationPros: Preserves bone, maintains natural tooth spacing, long-term success
- Cons: Higher cost, surgical procedure
Option 2: Fixed Dental Bridge.
- Extraction followed by preparation of adjacent teeth
- Bridge placement after tissue healing
- Pros: Faster timeline, no surgery
- Cons: Involves cutting healthy adjacent teeth, potential future bone loss in edentulous area
Treatment Performed.
- Local anaesthesia administered
- Atraumatic extraction of a fractured molar
- Debridement and curettage of socket to remove granulation tissue
- Placement of collagen plug and sutures for socket preservation
Post-op Instructions:
- Ice packs for swelling
- Antibiotics and analgesics prescribed
- Soft diet and oral hygiene care emphasized
Follow-Up & Future Plan.
- Re-evaluation in 2 weeks to monitor healing
- Discuss the timing of implant placement or bridge fabrication
- Patient education regarding hygiene around prosthetics and the importance of regular checkups