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The opinions within this web page are not ours. Authors have been credited for the individual posts and photographs where they are. -

Caries exposure of Tooth #18 - Courtesy ROOTS

The opinions and photographs within this web page are not ours. Authors have been
credited for the individual posts where they are -
From: Terry Pannkuk
Sent: Thursday, September 22, 2005 6:38 AM
Subject: [roots] Next Day Pain Emergency

Hereís an interesting one.  This patient was referred to my partner 
yesterday for a caries exposure of #18 with mild nonlocalized 
discomfort. She started treatment and placed CH  because the pulp 
was necrotic. He came back today having severe pain and couldnít sleep 
last night.  Percussion on #19 was severe and #18 was only slightly 
sensitive.   I transilluminated the tooth and there was a very clear 
fracture of the DL cusp. I accessed the tooth and found an incomplete 
crown fracture and Iím concerned about the  PDL space widening extending 
3mm subcrestal on the radiograph with a slight hint of  furcation bone 
loss. The perio findings were normal clinically but I couldnít probe 
accurately to the mid distal.

The tooth had a wild 5 canal system that at this point seem to all be 
separate, distinct  canals. I cleaned and shaped them and placed CH.  
I may extract the tooth and place an  implant if the tooth doesnít 
settle down or a perio defect clearly forms. Itís nice being 
able to perform both services of endo and implant. -  Terry

Terry , I love the transillumination photos, neat how the light stops.
You turn the lights out in the op and is the wand you use to shine light
one that Gary sells.
Thanks alot.....neat case and keep us posted whether it survives without
the need for tincture of titanium or not. - Glenn

It was just a cheapo transilluminator that you plug in the wall.  I turn
the light on the scope down about half way when I take these.  You can
actually see the light better in the photo than you can clinically - Terry

Hey Terry, Nice case as usual.

How long was 18 out of occlusion?  Many times when the distal abutment is 
taken out of occlusion (even for a short time) in a hard, tight bite 
(not to bore you with occlusal and orthodontic descriptions) the mesial 
tooth takes a beating.  I'm sure that fracture was there for a while, 
but the extra occlusal load may have pushed it over the edge - Arturo

My partner adjusted the occlusion on #18 the day before. - Terry
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