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 canal...as 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







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