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5 year recall of a horizontal root fracture - Courtesy ROOTS

The opinions and photographs within this web page are not ours. Authors have been
credited for the individual posts where they are - www.rxroots.com
From: Marga Ree
To: ROOTS
Sent: Tuesday, February 01, 2011 2:05 AM
Subject: [roots] 5 year recall of a horizontal root fracture

I have posted this case earlier and wanted to show the CBCT of the 5 year follow-up.

At the age of 13 this 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 at a dental school, with gutta-percha and sealer. 
I questioned the choice of the root filling material, it's an illusion 
to think that this could have been sealed with gutta-percha and sealer. 
His symptoms never went away, tooth was sensitive to percussion and had a
grayish discoloration. He got the advice to have the tooth extracted.

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, all this was done in 1 treatment session.
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 and CBCT shows a 5 year follow-up. When I posted 
this case for the first time, there was a lot of discussion about the 
poor crown/root ratio. He is 18 years old now, and he is doing fine, 
no complaints whatsoever. I thought it was cool to post the CBCT, 
you see only one slice, but when scrolling through the images, there 
is an intact PDL in every single slice! -  Marga

conventional retreatment

conventional retreatment

conventional retreatment

conventional retreatment Nice handling Marga: - you got the patient symptomfree after previous failed attempts - you performed surgical and non surgical retreatment on a 13 year old boy in single visit, avoiding patient management issues and multiple visits - you maintained an important tooth in the arch, maintaining bone level and esthetics - you got a healing 100 % not only on radiograph but also on CBCT level. - even if this will fail in the future, this lucky patient has now enough bone for proper implant placement Congratulations! - Roberto Great case and thanks for sharing. Now I know what to do next time I have a case like that --> leaving the extraction set in the closet and start the endo and surgery. It is amazing.- RafaŽl State of the art !!!! Thanks for sharing your cases!! - Chaniotis M. Antonis Dear Marga, I congratulate you great results in healing. I'm a big fan of your excellent work. My question is, what could be the reason that the tooth 11 is currently a little bit shorter than #21? - Alicja Dziedzicka, Warsaw, Poland Hi Alicja, Thanks for the kind words. I see what you mean, I have no idea, but I don't have the impression that the eruption of this tooth was disturbed at a certain point of time. What do you think? - Marga Great for your patient. I am sure he will enjoy this tooth for many years to come Wonderful as always. Great to see your posts again. - Thomas Shimco About the "short" appearance of tooth 11 in the 5 years period time, I guess it is very hard to comment something, as long as we are watching 2 different angulation of the pictures: one with closed mouth and one with the mouth open. To show exactely what I mean, I took my residency colleague Ricardo now in the clinic and in between 20 seconds I extruded his 11, than I luxated it with rotation of the axis, and than I felt pity for him and I intruded the tooth back. Only instrument I used was a Canon 350D taking pics from different angulations.- Roberto conventional retreatment

conventional retreatment

conventional retreatment

conventional retreatment

conventional retreatment Great explanation Roberto, I think you hit the nail on the head! - Marga Is this what they call photodontics??? - Peter Roberto, Thank you for explanation and very nice pictures? I think you are right, the long axis of this tooth is angulated. - Alicja Dziedzicka

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