From: Michael Pascal
To: ROOTS
Sent: Tuesday, February 02, 2010 8:56 AM
Subject: [roots] ominous defect (or not)

This patient was sent to me my the periodontist to pulp test #18.  He says I see a J shaped lesion at the distal
it must be fractured.  Oh really. The implant that was in #20 was in the patient’s hand. There was puss draining everywhere
on the left side.  #19 is ++++ mobile.  The patient hasn’t been to a dentist in 9 years. He has no idea when the RCT was done.
I told the periodontist that the tooth was normal and vital and the defect was NOT of endo origin.
I told him that it probed along the entire distal and on the DB toward the furca.  He said I know where it probes.
I asked him if he seriously through that RCT, even if it were indicated,  could rebuild the bone.  Their plan is to try and
keep the #18 to serve as a scaffold to help rebuild the bone in the #19/20 area.  They are also going to try and   graft
the distal of #18.   I said that if that were the case then I ought to do the RCT prior to the perio surgery as #18 had a
good chance of being devitalized.    I also strongly suggested that they CBCT the area (oh how I wish mine were installed),
and that they be VERY sure to biopsy the area as to me, this a very aggressive lesion with no obvious etiology (unless the
molar is fractured-which couldn't see clinically).   This periodontist almost never biopsies anything.  I did the RCT this
afternoon and did the Luxacore build-up at the same time.  Does this look ominous to you guys?   I'll keep you posted on
the biopsy result - Michael I Pascal



Wow! interesting case Michael!  It would be really interesting to see what the area looked like when the implant was placed.
If there was no perio disease related to #19 and the entire sextant blew out aggressively after the implant placement, you
would have to be suspicious of an aggressive nondental etiology.  I wonder if he screwed an implant into an odontogenic
keratocyst?   -  Terry