Monday, August 30, 2010

Would you implant or do RCT? - UPDATED

I work with some great oral surgeons & periodontists. I was recently asked to evaluate tooth #31 by my periodontist colleague. This patient had been referred to him for extraction and placement of an implant.



The periodontist realized that the bone loss around this root was not caused by periodontal disease. The patient reported no pain or swelling. He has no senstivity to percussion, normal probing depths (4mm depth on the buccal was the deepest) and when proper vitality testing was completed, the tooth was found to be necrotic. The tooth was diagnosed: Necrotic Pulp w/ Chronic Apical Periodontitis. The patient was given the option of endodontic therapy to retain the natural tooth.



Pulpal access revealed a necrotic pulp chamber.



Endodontic therapy completed and a 6 month recall scheduled to evaluate the periapical healing.
Please feel free to share your thoughts about these cases. The purpose of this blog is to generate discussion. What would you have done?


OK, here we are 3 years later. The tooth is asymptomatic and functional and perio probings are normal. Significant healing has occurred. There is still some lateral radiolucency - widened pdl, but at this point I think it was a good decision to retain the tooth.

Our specialty at Superstition Springs Endodontics is saving teeth.

5 comments:

Ruth said...

I love your blog, thank you very much for sharing. I have a question about this post, I know its old , but I am just curious!
Why is there a space in the last picture between the filling and the canal filling?

Thank you

Alejandro Pagán Ruiz said...

Hi Jason, certainly these types of cases are indicative of vertical root fracture, but in any case would have chosen the same option as you are always warning the patient of the poor prognosis of the case and that despite the microscope (essential to visualize possible cameral fractures ground level for example) sometimes for other reasons (eg occlusal trauma) fracture becomes more evident and would be indicated for extraction.

Another option would have made a CBCT to visualize possible fractures at this level, one of the main indications for this diagnostic test.

You could also have made an exploratory surgery to directly visualize the possible fracture, but in this case rule it out at first due to the screening done by the periodontist and the probing of not more than 4 mm in mesial roots, discarding a result intraosseus defects fracture.

Congratulations, after 3 years show that bone repair and is indicative that all is well.

I do not want before you leave without telling you that pascualendodoncia.com, endodontico.com and endoweblog.com (which I authored) have merged into a single blog (www.mb2.es). I hope you like it and your readers always so welcome.

A greeting.

Jason J. Hales D.D.S., M.S. said...

Alejandro,

Thank you for your comments. You have made great suggestions.

I will look forward to following your on your new blog: www.mb2.es

Anonymous said...

Prognosis was getting better after treatment. A "healed" case here :)

john said...

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