From: Terry Pannkuk
To: ROOTS
Sent: Wednesday, September 23, 2009 9:52 PM
Subject: [roots] Tale of Two Cities-Quiz

How about this consult from yesterday.

Patient: 57 year old male

Dental History:  adult ortho, Tooth #2 had previous resorption extensively involving the distal aspect,
it cracked, and was extracted in 2001.

This is specifically for Guy who recommended moving the severely tilted lower bicuspid through a mile
of 66 year old bone.  66 years old isn't necessarily old but the bone sure gets hard
(especially in the cranium :):):))

I'm not dead set against an ortho plan; I just wouldn't want to aggressively sell it based upon the
incidence of ECIR and association with adult ortho I constantly see.

Here's a good consult I saw yesterday.  I'm collecting these as treatment planning exercises for
postgrad students as I'm starting to teach at USC and UCSF.

Tooth #6:  5-6mm pockets circumferentially with a radiographically visible osseous crater, severe
gingival inflammation.  pulp tested necrotic, and a lingual crater can be probed on the lingual.
There is Class 1 mobility so it isn't ankylosed, no percussion sensitivity or other symptoms.

Tooth #11:  Normal perio findings, slight gingival inflammation upon probing especially the lingual aspect.
I didn't probe aggressively but suspect that if you really jammed an explorer deep into the lingual sulcus
area you might be able to penetrate a root crater.  Tooth tested vital, no symptoms, no percussion, and
all other clinical findings were within normal limits.

Dx #'s 6 and 11 ?    Treatment plan? - Terry



Canines were impacted and pulled down during ortho--one pulp didn't survive - B M Chauvin