From: Rafaël Michiels
To: ROOTS
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 patiënt:
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?  - Rafaël




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



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