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Severe pain and palatal swelling

From: "Guy Moorman" To: "ROOTS" Sent: Friday, February 06, 2009 8:22 PM Subject: [roots] A bear of a case I'm only posting this to Roots for consideration on what endo would have been like on 2. David Boag would love this one. She presented in severe pain with palatal swelling last week. I did an I and D with a drain. She returned on Monday of this week still in massive pain and it reasons were obvious. The radiograph shows just about the best shot we could get of this puppy with a PAX or a pan. With film motion we figured #1 was on the buccal. I could probe deeper than a perio probe from the middle of the "palatal" root to the buccal. I determined #2 would never heal. Calls to three oral surgeons got me appointments anywhere from one to three weeks. Now I do NOT do impactions any longer so they had no valid reason for rejection. I refer all impactions to the same guy and he was the one week out appointment. She was my partner's patient and had been on antibiotics for three weeks. OK, I'm going to have to do this. Was going to get 2 out and not mess with #1. This would relieve symptoms. 2 moved on elevation but suddenly stopped. I could see the roots on but I get those kinds all the time. Probing with the endo probe and some small endo packers drew me a picture of a problem tooth. I could feel the "buccal" roots but not the apexes. They were in bone. Nothing shows it but there were actually five roots on 2 with all fused but that male member. Mentally sat for a moment. Laid a full flat from the mesial of 3 scalloped around 2 and 3 cervically and onto the palate. It was a hell of a messy site but with two suctions going I could see that the "male member" was going to have to be retrieved separately so I sectioned it off with a very fine diamond. Everything was not going to come out together. After removing a little bone as possible, I simply pulled 2 buccally and it came out, leaving John Henry in place. It got sucked up into the evac and I retrieved it from the trap. Someone autoclaved it ...go figure. Now I could see the crown of 1 so I reached in and simply literally lifted it out. I had two syringes of bone for an implant site to do in three weeks so I placed up against the distal of three and placed a ton of Gelfoam in the defect. I closed the flap with 3O Vicryl. I love that stuff because it is like violin strings. You can lean on it and it won't break. You can pop it through contacts like dental floss which I did on the mesial of three. Took me twelve Vicryl sutures to close the defect but she was back this morning smiling...made me smile. 2 would have been one heck of a lot of fun to do endo on wouldn't it. There were two palatal roots fused and two buccal roots fused with a pure 90 degree turn. John Henry certainly was 90 degrees. I do not do these routinely and had to sit for a moment to bring back the military in me. Then I plowed in. I charged her 400 bucks, which was more than she could afford but about 1100 bucks less than the OMFSs told her to bring. Didn't do much for my bottom line :-) but made me feel good. Don't plan on ever doing one of these again. A young lady dentist had come over to have me put a piece of implant tool together for her and she simply said, "you are crazy". I truly am. - Guy W. Moorman, Jr. DDS

Nice job Guy! I dont know what you call this in the Swamp, but around here we call it a mo'fo - Arturo About the same down here.- Guy W. Moorman, Jr. DDS Deepshikha Gupta commented on your post Aug 4,2013 in Clinical Cases And Discussion.....A sharing platform for Dentists. nice one!

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Apical in DB
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Tooth # 4
Dumbing down of dentistry
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