4 year follow-up of a trauma
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From: Marga Ree
Sent: Tuesday, July 26, 2005 01:11 AM
Subject: [roots] 4 year follow-up of a trauma
This patient was referred to me 4 years ago, after he sustained a
dental trauma. At that time he was 11 years old. Tooth # 11:
horizontal root fracture, tooth # 21 AP with a sinus tract, and
a wide irregular pulp canal space, due to a resorption process.
Thermal tests on tooth # 11 WNL, no sensitivity on percussion and
palpation. I decided to monitor # 11, the only therapy consisted
of a restoration of the crown fracture with an adhesive composite.
Upon access of # 21, there appeared to be a perforation to the distal
and the mesial, due to the resorptive process. Ca(OH)2 for a few weeks,
application of MTA in the apical part, composite in the middle and
coronal part of the canal to reinforce the tooth, and a cosmetic
composite build-up. The sinus tract had almost disappeared at the
time I finished the case, see clinical pics.
16 months follow-up showed PCO in # 11. The tooth didn't respond to
thermal tests and EPT. However, no discoloration of the clinical
crown. # 21 was doing well, no complaints, sinus tract disappeared completely.
Today I received the rad of the referring dentist of the 4 year
follow-up. I didn't see the patient myself. The PCO has progressed,
but, according to the referring dentist, still no signs or symptoms.
I do see a kind of a radiolucent area at the obliterated root,
apically and coronally of the fracture level, what do you think?
Or is it just my imagination? - Marga
I believe I see what you are seeing, but I’m attributing it to normal
radiographic changes in a tooth undergoing orthodontic traction.
I think I’d be of the mindset to monitor it some more - gary
Marga, did the patient have orthodontic treatment in the meantime?
It will be interesting to see if there is any distraction of the apical
fragment during the orthodontic treatment - Stephen.
Dear Marga, mesial and coronally of the fracture line it seems to me
if there is some area of external resorption - Bart
I do see this area as well---a rather large, ovoid area? if we are
talking about the same area, i'm not sure what to
make of it either, sorry no help, - Kendel
Marga it does look like a radiolucent area apically and coronally to
the fracture line..............................
One question regd. packing the canal space with composite .........
.........What bond do u prefer........ I mean which generation and
what type of composite do you use? Is packable posterior composite a
choice and are you depth curing the composite ? - Sachin
A packable composite is way too stiff to apply in a canal space.
I prefer a self cure build-up material with the right consistency to
put it in a needle tube and squirt it in the canal space, for me
LuxaCore does the job. LuxaCore is also available in a dual cure
version. The reason for me to choose a self-cure, is because their
relatively slow-setting rate are thought to provide flow to relieve
the shrinkage stress developed during setting. For bonding material,
see attached pics - Marga
I use gold Build It for this, Marga. It leaves a soft back ground
for all porcelain crowns and is easily identifiable
as not being tooth. Guy
Marga: Do you have any concerns that by placing a composite post/core
buildup of that magnitude that you may be committing
the patient to surgery in case of retreatment as access may be
difficult? - Gary
Gary, In this case I placed a fiber post in the bulk of composite.
I do this amongst others to facilitate retreatment if
necessary. You can remove a fiber post quite easily, provided you
have a scope and can see what you are doing. Another
advantage is that by placing the post, you're reducing the mass
of composite and therefore reducing the polymerization
shrinkage. It also gives the build-up more stiffness. These are
some of the reasons that I usually insert passively a
fiber post after making a build-up of composite of that magnitude - Marga
Somehow I couldn’t see you cramming composite 2/3 the length of a root,
but somehow I missed the fiber post part. Sorry about that - Gary
It is difficult, if not impossible to see, due to lack of radiopacity
of the post. I found your remarks very adequate - Marga