4 year follow-up of a trauma : percussion : sinus tract

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4 year follow-up of a trauma




The opinions and photographs within this web page are not ours.
Authors have been credited  for the individual posts where they are.
- Photos courtesy of Marga - www.rxroots.com

From: Marga Ree
To: ROOTS
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? - Jörg
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

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