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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. - www.rxroots.com

Deep distal perio pocket


From: Terry Pannkuk
To: roots
Sent: Wednesday, March 14, 2012 8:50 AM
Subject: [roots] 2 1/2 hour consultation

I donít think itís a good idea to offer a CBCT exam as a free service.  This is the report 
I stayed late this evening to finish as it was a full mouth reconstruction case. Iíll probably 
just do the endo on #3 and thatís it    The patientís appointment was 2 Ĺ hours, the report was 
extra time this evening after work looking at the two stitched CBCT scanned arches 
(luckily I can type fast):

1. Patient arrived didnít do the online medical history, but he was  healthy.
2. Assistant took blood pressure, dental history,  pain history,  etc. etc. and then did clinical 
   exam/tests
3. I reviewed the assistantís findings in my office to sort out a strategy for my exam with the 
   notes    below in rough draft.
4. I introduced myself to the patient clarified aspects of the medical/dental history.
   Next I asked the patient about his expectations to see if they jived with the referring dentistís
   (the dentist is excellent and one of the best in town). Performed an oral exam,  repeated all
   significant relevant clinical tests for redundant accuracy adjusting chart if necessary..
5. I corrected and updated all my rough draft notes and decided whether it was possible to sequence
   and prioritize and endodontic treatment order (it wasnít necessary because the #3 tooth was the
   only definitive recommended endo treatment).
6. I discussed all the significant endodontic related findings with the patient (i.e. the list below)
   and answered all his questions (there were many).   I mentioned that I may adjust some of my findings
   based upon my review of the CBCT data (later after reviewing the scans I defined #3 as clearly needing
   endo and #24/25 as not being reasonable to treat) .
7. I sent the following report to the referral. He will call me back and weíll discuss the next step
   which will likely be scheduling him for #3.  I fully expect to see this patient again in a month
   or two when he is in provisionals for re-evaluation of teeth that will likely need an endo evaluation
   after the crowns are removed and pulps are exposed.
8. This referral likes me to do implants for him but if this ends up being a largely edentulous case,
   Iíll decline because itís well beyond the scope of my specialty boundaries and this one wonít be
   within my implantology niche.

Hi xxxxx,

I saw xxxx in 2008 for the right posterior lower sextant.  I examined all areas today.
The following are the summarized notes with the multitooth chart information below.
Attached are images of the teeth having significant findings or of specific interest.

#2:  deep distal perio pocket may improve with wisdom tooth extraction.   Endo retreatment with post
     removal advised if a new restoration. (guarded to fair prognosis primarily due to perio if not 
	 fractured)

#3: necrotic pulp,  CBCT shows a radiolucency/lesion over the MB root apex Endodontic treatment advised.

#7: previous endo a little short but no evidence of recurrent endo pathosis. Tough call to redo endo
    if a new crown is planned.  Iím not sure what the weakly radiopaque material is cementing the post
    which seems to be injected well past the apical extent of the post.  If  itís nonresorbable it may be
    problematic to retreat/remove without apical surgery.  CBCT shows no periradicular radiolucencies
    suggesting recurrent endo disease.

#9: Filled grossly short, possible paste or MTA root filling material.   I strongly suspect previous
    pulp obliteration with an attempt to negotiate a nonnegotiable system was filled short.   Iíd recommend
    leaving it alone and doing surgery later if necessary.  CBCT suggests no evidence of recurrent
    endodontic disease.

#10:Previous endodontic treatment looks adequate with no suggestion of recurrent endodontic disease.

#14:Possible exposure, distal pulp horn,  cold thermal response was normal.  CBCT scan showed no
    suggestion of endodontic disease.

#15:Previous silver point endo, with poorly filled palatal root terminus (no observable material).
    Likely missed MB2  (impacted #16 should be taken out).  CBCT showed no evidence of recurrent
    endodontic disease.

#19:Failing previous endodontic treatment, retreatment with bicuspidization would likely fail due
    to root fracture and would be extremely heroic/impractical.  Extraction advised.

#24:Type II Heithersay resorption mapped on the CBCT as limited to the lingual surface.
    Considering the advanced labial abrasion and cervical weakening, the prognosis is poor and
    extraction is advised.

#25:Type III Heithersay resorption, worse prognosis than #24,  the defect was also mapped on the
    lingual and is larger. Extraction is advised.

#30:Previous endo with unsuccessful management of root external lateral inflammatory root resorption.
    Chronic furcation lesion. The status does not look a lot different from when I examined him in 2008.
    It still has a poor prognosis with a chronic furcation lesion. Advanced inflammatory root resorption.

#31:Advanced root inflammatory root resorption with failing previous endodontic therapy, very poor
    prognosis, extraction advised.

Thanks for your trust and support, - Terry

deep distal perio pocket

necrotic pulp

distal pulp horn

silver point endo

tooth #19

type II heithersay resorption

type III heithersay resorption

root fracture

root inflammatory

Occlusal trauma

Premolar and RCT

Resistant lesion

Screw job

Geristore resorption

Curved MB canal

Tectraciclin in surgery

Root resorption

Endo perio lesion

Crack resorption

Mandibular molar

External resorption

Rubber dam limits

Middle mesial

3D obturation

Inflammatory resorption

Hess anatomy 3

Wierd upper 2nd molar

Implants and/or teeth

Cracked tooth syndrom

Crown root fracture

Open Sinus lift

Mandibular nerve

Missed DL canal

Apical Periodontitis

Endodontic autopsy

MM Canal

3 visit retreatment

Deep bifurcation

Dangerous curve

Lower wisdom

Coronal lateral

Hess anatomy

VC Obturation

Diagnostic trivia

Sinus tract

Extraction & Clearing

Tooth #2

Implant placement

tooth clearing "technology"