Necrotic CPP with symptoms - Courtesy ROOTS
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From: Fred Barnett
Sent: Friday, March 05, 2010 11:29 PM
Subject: [roots] 1 yr f/u re-tx of my own case....2nd year resident case
from 2nd year resident.....
Here's the 1 yr follow up on a case I did. Healing in progress. The history below is what I had sent out
last year with the case. Pt is asymptomatic now and doing well, except he still hasn't gotten anything
restored. What a pity!
Pt came in with pain on #31. Necrotic/CPP with symptoms. Bridge from #29-31 with recurrent caries.
Discussed sectioning bridge, single crowns on #29 and 31 (after tx #31 and re-tx/possible apico #29) and implant #30.
Don't like the bone too much in area of #30, but will re-eval for implant at next visit.
Started tx #31. Upon access, there was exudate present. Managed to separate a #10 file with the M4 in MB
and it took me an entire appointment to get it out. Used 'tube and glue' method.
Pt called back 2 days later in "excruciating pain and swelling" in the submandibular region. Rx Pen VK.
It wasn't sufficient. Pt called back the following day reporting increased swelling "the size of a golf ball".
Pt wasn't able to come in that day. Dr. Trope advised to add Metronidazole to the Pen VK to take concurrently
and I asked him to come in the following day and go to ER during the night if impaired with breathing.
At the second visit (the re-tx visit) there was still exudate being expressed from the mesials. Unable to dry.
Placed new Ca(OH)2 after debrid/disinf.
Pt came in for 3rd appt. No exudate, no pain; completed case. There was quite a bit of troughing in coronal
portion of MB to access the separated file, as you can see from the final radiograph.
Any comments/suggestions are welcome! - Melissa"