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Necrotic CPP with symptoms - 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: 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"

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Bicuspid tooth

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