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






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.- Rafaël

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







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