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Gingivitis, DPSI 2, some caries - 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: RafaŽl Michiels
Sent: Saturday, June 12, 2010 3:47 PM
Subject: [roots] Is this lost or would you give it a try.

My girlfriend sent me an email about the following patiŽnt:
A 45 year old male came to their practice for the first time in january 2010:
Clinical situation: Gingivitis, DPSI 2, some caries
They performed a thorough calculus removal and some fillings.
The bridge is placed by another dentist, no information.
Last week the patient returned with an abces with sinus tract buccally 
of the 21 (#9). No spontaneous pain, percussion sensitivity ++, antibiotics was 
prescribed by the patients general physician, without success.
The abces was drained and a PA radiograph with a small guttapercha cone was taken.
There appears to be a resorption in the root.
Probing was somewhat deeper in the buccal area, but this can be because of the 
abces and the gingiva being 'pushed up' locally. No vitality testing was done.

This email was first sent to the periodontist (asking for exploration surgery), 
which replied that the tooth is probably lost because of external root resorption. 
(no consult was performed however, this was based on these two radiographs)

I asked my girlfriend for details about the situation and radiographs and when 
looking at this, I am not sure that the tooth is lost. (At least, I will look 
at it in real life)

What do you guys/girls think?
Internal resorption, external resorption, fracture?

Here is what I would do:

1st: Consult with taking of extra angled radiographs, vitality testing 
(though the prosthodontics      won't make that easy), etc...
2nd: NSRCT in 2 visits and then looking wether or not there is a perforation
3rd: possible additional surgery, in case this is required after assessing 
this in step 2.

Anybody would do this different? If so, what would you do? Sent the patient 
for a CBCT?  - RafaŽl

Well, The periodontist took a scan and the tooth is lost. It's an external resorption on the palatal side. See attached image - Grtz, RafaŽl

Actually palatal side lesion is more manageable than the buccal. esthetics can be managed better. the scan is not very clear. any other pics? - Sashi
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