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1/2 1/3 Root Fracture

From: Nuria Campo To: ROOTS Sent: Monday, January 21, 2008 6:55 AM Subject: [roots] 1/2 1/3 Root Fracture. Treat or not treat? Female, 68 yo No conscious of previosus trauma. Referred by a colleague for evaluation because he is not able to establish diagnostic. In any case some valuable information registered on the 1st visit provided to me for the referral GP. GP evaluation: August 2007 Patient cancelled one visit with me and reapears on: Dec 2007. Follow-up: January 2008.
Aug 2007 Dec 2007 Jan 2008
  Referral Doc    
Chief Complaint   Sensivity to cold&hot Sensivity to cold&hot Sensivity to cold&hot
  #9 is darkening "#9 is black" (patient words)  
Symptoms Casual discomfort chewing Casual discomfort chewing Avoid chewing w/ #9
Tooth color Abnormal (color ???) Normal Lightly yellow
Percusion tenderness  +  +
Palpation tenderness  --  --
Oclusal contact tenderness  +  +
Cold Pulp Test  +  +  +
Mobility  I  I
Periodontal Probing  normal  normal
Rx Tests  No done Periapicals (apical, orto, coronal)  
Rx Findings 1/3 1/2 Root Fracture  
  Apical calcification of the canal  
    Segments lightly sepatated  
Healing Process Guessed   Conedtive tissue between fragments ???  
Diagnostic   1/3 1/2 Root Fracture  
    2 fragment vitals  
Follow-up    next moth next moth
Treatment Plan     ???
Treat or not treat, thats the Question? Every suggestion will be welcomed. - Nuria Campo Hi Nuria, I would treat with root filling to the fracture line----let's see if other opinions will agree - Kendel Nuria, One approach we have see work in our own case, Use smart endo (LightSpeed) it help you to seal apex with a simplifil, in rest of the canal seal CaOH or MTA and stabilise the tooth by a FRC splint for 8 weeks - Dr Goel Hello Nuria, In the absence of periradicular disease and in the presence of positive reaction to temperature, I would RECOMMEND relieving the occlusion, care (not biting into hard food) and monitoring. The yellow discoloration occurs in the presence of pulp calcification. If the symptoms / signs do not subside then the RCT for the coronal segment would be indicated. However, I would also discuss with the patient the option suggested by Kendel and also the options of no treatment and extraction. I hope this helps - Ghassan Hi Nuria, nice case If change in color is the main concern, I would treat the canal to the fracture line, and live the apical segment undisturbed. Thereafter tooth whitening. Occlusal adjusment to avoid excentric forces and instruct the patien to avoid trauma - Carlos About the case, Dr Goel according to the last Trauma Guidelines recently shared in the forum, the best prognosis if RCT is required is donŽt touch apical portion. Usually the nerve and vessels are inside and then a calcification process starts and thats all. And if apical radilucency appears is better extract the apical fragment. But I appreciate your opinion. Kendel, Gasshan, Carlos and Guy added interesting points. Both fragments are vitals at the moment like in your case Guy. If the symptoms and signs follow like know probably IŽll expect and follow-up like Gasshan suggest. But maybe if the Aesthetic is being more and more compromised or the patient insist in this point IŽll decide to treat the coronal fragment like you suggest Carlos. ppt slides to jpg has worked Carlos. Thanks for your help in this. My former cases were shared with Picasa, but it cuts part of the images .... My case documentación is improving with roots too. IŽll take pics the next time - Nuria Campo
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