2 year follow-up of a trauma case - Courtesy ROOTS
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Photos courtesy Marga Ree - ROOTS
From: Marga Ree
Sent: Saturday, March 08, 2008 8:13 AM
Subject: [roots] 2 year follow-up of a trauma case
I have posted this case earlier and wanted to show the 2 year follow-up.
This 13 year old boy sustained a trauma on tooth 11. Unfortunately, the
horizontal root fracture was treated by his dentist by performing an endo
in the 2 segments. Because of persistent complaints, the coronal segment
was retreated by a resident of the endo program, with gutta-percha and
sealer. I question the choice of the root filling material, it's an
illusion to think that this could have been sealed with gutta-percha and
sealer. However, his symptoms never went away, tooth remained sensitive to
percussion and had a grayish discoloration. He was recommended to have the
tooth extracted, because everything that was possible had been done.
I performed a conventional retreatment till the fracture level, filled the
coronal segment with MTA, raised a flap and removed the apical fragment in
2 parts, this was done in 1 treatment session. After removing the sutures,
we applied sodium perborate for a few days, and the access opening was
filled was with composite.
Healing was amazing, after 2 months tooth was rock solid and patient was
completely symptomfree, for the first time since the trauma took place.
The last rad is the 2 year follow-up - Marga
Dear Marga, just beautiful. What a great service for the patient. - Jörg
Marga, thanks for sharing this amazing case! It is a miracle of thought and
fine skills. One question however, did you only inspect the fracture line or
did you preped coronal fragment to smooth the surface? Did you do retrograde
prep and obturation or just polished that MTA which you have orthogradly placed?
- Dmitri Ruzanov
Thanks Dmitri! I prepped the fracture site gently to smooth the surface and
the orthogradely placed MTA. I didn't add extra MTA after this procedure. - Marga
Marga: Your treatments always stun me. There are people like yourself,
Jorg, John Levinje, Khademi, Rod Tataryn that I dive into their emails when they
post their work. You all set the bar so high with your clinical treatments and your
wonderful documentations. Bravo Marga.....you are a tremendous clinician.
This case surprised me that the tooth would hold......I didnt think it would.
CLAP CLAP CLAP - Glenn
Marga, The apical fagment, which should never have been treated anyway, was
very poorly sealed based on what your beautiful photographs show.
Your result is fantastic. - Dan Shalkey
Thanks Dan. As you said, the best treatment on a horizontal root fracture
is no treatment, except for splinting. The pulp in the coronal part remains
vital in the majority of cases. Sadly, many clinicians are not aware of
this. - Marga
Do you routinely use white MTA in anterior teeth? - Andreea
Dear Marga, excellent result. Could you share your osteotomy technique
How did you remove what appears to be the palatal fractured segment of the
coronal tooth (not the fractured apical segment)? Thanks! - Tony
Hi Tony, For osteotomy I use an impact air handpiece with a Lindeman H 151
tapered bur. The fracture is usually not a perpendicular one, but an oblique
fracture, of which the most coronal fracture line is located at the palatal
side. This was also the case here. I sectioned the buccal fracture line
perpendicular to the long axis of the root, and removed it, first pic. Then
there was a remaining segment, attached to the palatal mucosa, which was
the most difficult part to remove. I carefully severed it from the palatal
mucosa with a scalpel blade and a sharp excavator. In this way, you save
as much of the root as possible. If you look at the last 2 pictures, you
can see how the 2 segments were located in relation to each other.
The smallest, most coronal segment was located at the palatal side. - Marga
Hi Marga, I had thought perhaps you used a special root elevator, etc, but it
looks like a excavator worked well. Thanks for the explanation. - Tony
Beautiful healing marga, although I still question the long term prognosis of
this case. But at age 11, now 13, if you can keep that tooth functional through
the teenage years, it is a great service to the patient and better than the
prosthetic alternatives. - gary
Dear dr Ree,
your case impressed me equally as a dentist(GP) and..as a mother:), who's child
has finally received the correct therapy! Furthermore, your images are brilliant,
THANKS for sharing them so kindly... Cristina Ghita
Dear Marga, excellent case as usual, but, why don't you use Leubke-Oschenbein
flap tehnique, and 5-0 nailon , it doesn;t leave any scar. - Sergiu Nicola