5 year recall of a horizontal root fracture - Courtesy ROOTS
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From: Marga Ree
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
- 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
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