Background and overview: The term "fracture necrosis" has been used to describe the condition found in a minimally restored tooth without a history of trauma when the suspected etiology for the loss of pulpal vitality is a crown-originating fracture. Teeth with fracture necrosis have a poor prognosis, and, when accompanied by characteristic radiographic findings, extraction may be considered the primary treatment option.
Case descriptions: Two adult men with crown-originating fractures and suspected fracture necrosis had localized periodontal bone and attachment loss associated with severe pain on mastication from mandibular second molars. In case 1, the patient desired to retain the tooth despite an unfavorable prognosis. Nonsurgical root canal therapy and a crown prolonged tooth survival for only 30 months. The patient in case 2 requested extraction after a thorough review of his dental condition and tooth prognosis.
Conclusions: A tooth with fracture necrosis may continue to harbor virulent microorganisms after root canal therapy. When these microorganisms have access to the periodontal attachment, progressive loss of supporting tissues can be expected.
Practical implications: When weighing treatment options for teeth with fracture necrosis associated with characteristic radiographic findings, preference toward extraction and tooth replacement, rather than treatment aimed at tooth retention, may represent a sound clinical approach.
Keywords: Diagnosis; pain; prognosis; tooth fractures; treatment outcome.
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