Dentist said possible crack through distal cusp of molar tooth, making restoration questionable - based on x-ray, thoughts?

[ToothPatient]

X ray was taken last Friday.

2nd molar on top, the tooth that's heavily filled.

See the bottom right hand side, that dark line that traverses from the corner of the tooth, in and upwards?

Then see the distal end of the same tooth about 3/4's up the surface, that black'ish area?

Is it possible a crack extends from that line to that dark'ish area, indicating a cuspal crack?

Periapical taken at the same review, shows the beginnings of an abscess around the upper roots where the margin of the root is darkened?

I was in agony at this consult and couldn't touch the tooth at all. It also felt "high" when biting, like it was being pushed out.

Three days on anti-biotics have really settled that agonizing pain though and I can chew on it again.

........

Endo said a couple weeks back he could do the first stage of root treatment and assess what's what once he's inside the tooth, see if the cracks are deep etc.

Does that sound appropriate based on these x-rays?

 

[ToothPatient]

Some photos also:

Occlusal

Buccal

Lingual

 

[Dr Sunali dental Solution]

Given that you have observed a dark line that traverses from one part of the tooth towards another distinct area, it is indeed possible that this indicates a cuspal crack extending between these two points. However, definitive diagnosis would require clinical examination and possibly further imaging (such as cone beam computed tomography) for better visualization of internal structures.
Therefore, based on your observations and typical presentations of cuspal cracks in dental radiography:
Yes, it is possible that a crack extends from that line to that darkish area, indicating a cuspal crack.

Based on your symptoms and X-ray findings indicating a potential abscess around the upper roots of your tooth, proceeding with endodontic treatment as suggested by your dentist is indeed appropriate. It allows for both immediate relief from infection and long-term management of any underlying issues affecting your tooth’s health.

 

[ToothPatient]

Given that you have observed a dark line that traverses from one part of the tooth towards another distinct area, it is indeed possible that this indicates a cuspal crack extending between these two points. However, definitive diagnosis would require clinical examination and possibly further imaging (such as cone beam computed tomography) for better visualization of internal structures.
Therefore, based on your observations and typical presentations of cuspal cracks in dental radiography:
Yes, it is possible that a crack extends from that line to that darkish area, indicating a cuspal crack.

Based on your symptoms and X-ray findings indicating a potential abscess around the upper roots of your tooth, proceeding with endodontic treatment as suggested by your dentist is indeed appropriate. It allows for both immediate relief from infection and long-term management of any underlying issues affecting your tooth’s health.

Cheers.

Had a CBCT scan last Friday, no cuspal crack was visible.

I think the review dentist mistook the sensitivity of abscess formation/onset (as per the periapical x-ray above), for a crack causing that pain.

Three days of antibiotics has got that pain to settle, presumably indicating it was indeed cause by abscess onset, and not by this supposed "crack"?

As I understand cracks tend to be more microscopic and not necessarily highly visible like that photo shows?

In any case, first stage root canal on Thursday, we'll see what happens there. Endo said a crack may be more visible once he opens up the tooth, or if there's continued pain after he removes the roots, that might indicate something more underlying....... such as a crack (tooth is positive for bite test on release).

......

I just hope I never have to experience abscess pain again, and hopefully I can finally begin to get out of this general pain I've been in for five months now and finally get this tooth addressed.

 

[Dr Sunali dental Solution]

Cheers.

Had a CBCT scan last Friday, no cuspal crack was visible.

I think the review dentist mistook the sensitivity of abscess formation/onset (as per the periapical x-ray above), for a crack causing that pain.

Three days of antibiotics has got that pain to settle, presumably indicating it was indeed cause by abscess onset, and not by this supposed "crack"?

As I understand cracks tend to be more microscopic and not necessarily highly visible like that photo shows?

In any case, first stage root canal on Thursday, we'll see what happens there. Endo said a crack may be more visible once he opens up the tooth, or if there's continued pain after he removes the roots, that might indicate something more underlying....... such as a crack (tooth is positive for bite test on release).

......

I just hope I never have to experience abscess pain again, and hopefully I can finally begin to get out of this general pain I've been in for five months now and finally get this tooth addressed.

It seems likely that your recent pain was related to an abscess rather than a visible crack based on antibiotic response, only time and further examination during your upcoming root canal will provide definitive answers. It’s good that you’re addressing these issues with professional care; hopefully, this will lead to relief from your prolonged discomfort.