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Fracture in Coronal portion of incisor

From: Noemi Pascual Herrero
To: roots
Sent: Saturday, September 24, 2011 5:45 AM
Subject: [roots] Any chance?

Here I present another case. She is a female 24 years old, 
diabetics with periodontitis under control from last
2 years.

6 years ago the patient fainted because of the diabetes and 
had a trauma in 21 due to this. She had a fracture
in the coronal portion of the incisor and they did the build-up. 
1 year and a half ago the patient came back to
the same practice with pain and discolour of the 21. 
They did the RCT in 21. Now they refer the patient to me for 
evaluation of the sinus tract in 21. Perio probings are 2-3mm 
in the lingual face but in the vestibular face is between 9-6mm. 
She is assymtomatic but tenderness to palpation and percussion. 
Intrusion o 21 of 1,5mm. The sinus tract is also almost close so 
it is not possible to enter with a gutta perch cone. We were 
discussing this case with the other 2 doctors of the practice. 
The periodontist and myself decided to go to the retreatment of 21. 
If not healing we will do an exploration surgery before deciding 
anything. The third doctor thought about extraction and implant.

I am thinking about a lateral you see in the rx it 
seems it beginned to be fill a little bit with the sealer.
Notice also the radicular reabsortion of the 22.

What´s your opinion?  - Noemí

coronal incisor

coronal incisor

coronal incisor

coronal incisor

coronal incisor I would give retreatment a chance before implant. - Chaniotis M. Antonis Noemi, Basically this tooth is a goner, due to its periodontal status and extend of bone lesion/loss. Combined re-treatment and surgery may possibly give it another year or two,... or may be more :-). Tooth should be splinted before surgery and stay splinted for couple of months after surgery imo. More definitive kind of treatment would be extraction and implant. Aesthetic issues if an implant is chosen would be of consern in this case. - Valeri Stefanov Hi Noemi, I would try retreat first - Imran Extraction is the best choice- Bruhvi Parikh

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