This patient came to our office for treatment in 2005. Tooth #30 was diagnosed with a necrotic pulp and chronic apical abscess. Periodontal probing around tooth #30 was normal. Despite the large lesion into the furcation, this was determined to be an endodontic lesion.
Endodontic treatment was completed.
16 months later, the patient returned with swelling. Orthodontic treatment was underway. The apical lesion had failed to heal, and even gotten worse. Surgery was recommended to evaluate the lesion for possible root fracture.
Large amount of granulation tissue removed from large boney defect.
Biopsy Dx: Periapical Cyst
Following the apicoectomy, a MTA retrofill was placed in all canals. No fractures were found. The orthodontic treatment was discontinued for a period to allow for healing.
The patient came in last week for a nine month recall. The patient is completely asymptomatic, the apical healing is almost complete.
As a review, this is a tooth that failed to heal with non-surgical endodontic therapy. This tooth while loaded occlusally, underwent orthodontic forces, endodontic surgery (without bone grafting) and had significant bone regeneration at nine months.
There are many dentists who would have extracted this tooth without considering the option of endodontic treatment or surgery. Modern endodontic microsurgery provides our patients with another option for maintaining their natural teeth. It should be considered when we are doing our treatment planning.
3 comments:
Wow....interesting blog. I deal with knocked-out tooth and work closely with an endo.....your visual pictures, really nail it.
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Hey that's a nice result. Pretty dramatic healing considering the size of the lesion and only 9 months.
How old was the pt?
Thanks Ameloblast. The patient was in early 30's.
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