Case Model 2
Crown vs Root Canal
Case Summary
Maxillary premolar
Large existing composite
Patient reports intermittent cold sensitivity
No spontaneous pain
Radiograph shows deep restoration approximating pulp
No periapical radiolucency
Occlusion moderate
No known bruxism
1. Structure Assessment
Large MOD composite
Moderate remaining dentin thickness
Marginal ridge integrity compromised
No visible crack extending beyond pulpal floor
Periodontal support intact
Structural reserve: Moderate
2. Force Assessment
Normal occlusal load
No heavy lateral contacts
No reported parafunction
Force risk: Low to Moderate
3. Time Projection
Sensitivity intermittent, not progressive
No spontaneous pain
No radiographic pathology
Restoration age 4 years
Compliance acceptable
Time risk: Moderate
4. Long-Term Stability Projection
Under Preservation (Crown Only)
Vital pulp maintained
Internal dentin preserved
Structural reinforcement via cuspal coverage
Fracture probability reduced
Long-term stability acceptable if pulp remains healthy
Under Escalation (Root Canal + Crown)
Internal dentin removed
Loss of vitality
Increased fracture susceptibility long term
Replacement pathway narrowed
5. Threshold Position
Does projected force across projected time exceed structural tolerance under preservation with crown only?
No.
Pulpal symptoms are present but not indicative of irreversible pulpal degeneration under current data.
Structural tolerance under crown coverage remains acceptable.
Threshold convergence not confirmed.
Decision: Crown without root canal indicated. Monitor pulpal response.
This demonstrates: Diagnosis alone does not justify endodontic escalation. Threshold requires convergence across structure, force, time, and long-term stability.