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Trauma Case
The opinions and photographs within this web page are not ours. Authors have been credited for the individual posts where they are. - www.rxroots.com Photos courtesy of Mark Olesen
From: Dr. Mark Olesen
To: ROOTS
Sent: Wednesday, May 09, 2001 1:11 AM
Subject: [roots] Trauma case

I would appreciate some opinion on this case.

16 year old male.
trauma in march 2000 to lower incisors, severely displaced lingually. Under
general anesthetic, orthodontist repositioned and splinted.

Referred to me in Dec. 2000. Mandibular 4 incisors all non-responsive to CO2
ice. Inflamed gingiva on facial of  #s 31, 41, 42 (#24, 25, 26 for
americans). Mother is a hygienist and said that the soft tissue lesions
appeared within a couple weeks after the trauma (March 2000).

I initiated RCTs in Feb. 2001 and placed intracanal CaOH. RCTs completed
last week (2 months later).

Soft tissue lesions still present, perhaps a result of infected tubules  ->
root surface resoption -> soft tissue lesions. However, no radiographic or
clinical evidence (feeling with an explorer) of external resoption.

Intraoral image   Pre-operative image
Post-operative image
thank you for comments on histological etiology and treatment suggestions. - mark olesen The fill on #24 looks kind of wierd in the junction of the middle/apical 1/3 of the canal-almost like there was some sort of resorptive defect. What do you think? I'm grasping at straws here. Maybe you should consult a periodontist? Would this be a case in which surgical exploration might be warranted? - Mark Dreyer, DMD, PA Regarding the gingival inflammation:
  • we are assuming that there is no exudation and/or probing defects; if probing defect exists, place a size fine gp point and trace as you would a sinus tract
  • make sure that there is no residual bonding or composite material subgingivally
  • scale area (under local anesthesia if necessary); (bone fragments from original trauma?)
  • chlorhexidine rinses; bidx14days
  • take angled radiographs and use thin explorers to rule-out cervical resorptive defects, root fractures, cemental tears(?)
  • please keep us informed; thanks for showing the case!!
- Fred From: Jörg Schröder To: ROOTS Sent: Saturday, September 16, 2006 12:28 AM Subject: [roots] Trauma-Case, Opinions please 15 y. old male, trauma 12 months ago, ortho had already started, after 9 month #11 started to change colour. Since that time sensitivity to cold never got lost, although changed in intensity. Right now sensitivity is delayed. No swelling, no mobility, no fistula, no pain. What is the right way to treat this one? I don't want to "kill" the pulp. Discoloration isn#t the problem right now, but may be in 2-3 years. I recommended x-ray recalls to be able to recognize any signs of resorption.
Opinions are very welcome. - Jörg Schröder

hello Dr Schroder, i think its on its way towards death and sooner or later endo would be needed, imho keepchecking vitality and radiographic monitoring , if on ciold test no pain .......... nsrct - Gurpreet I am thinking the same way, never heared about discolration and sensitivity to cold at the same time. Any explaination for this? - Jörg I think there is still vital pulp apically and it is necrotic coronally and blood component is totally gone , just the nervous component is left - Gurpreet Hi Chris, as the ortho-teatment had already started and Pt. consulted the orthodontist, I am not thinking about an intrusion . Maybe a lateral dislolcation. And as far as I know, about 50% of those lateral dislocated teeth will have a necrotic pulp - Jörg

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