Case of the Month June 2010
Case 1: Patient is 28 y.o. female who presents with the Chief Complaint of discolored #8. Her medical and dental history were unremarkable. She had no history of trauma to her maxillary anteriors that she could recall. Clinical exam revealed discolored #8. Vitality tests were normal for teeth #7,9. Tooth #8 did not respond to thermal tests, had normal percussion and palpation, and her probing depths were WNL. She desired #8 to be “lightened” to match her adjacent teeth and did not desire to have a crown or veneer placed to mask the discoloration. Radiographs revealed #8 had undergone calcific metamorphosis. Periradicular tissues appeared WNL.
Pre-op images – the apparent canal line that is visible in the image is actually the sensor. Believe me, the canal was completely obliterated clinically.
Case 2: Patient is 51 y.o. female who presented with the Chief Complaint of sensitivity to cold and tapping tooth #22. Her medical history was quite extensive with positive entries for Ehlers-Danlos, Medullary Sponge kidney, Sjogrens disease, Asthma, Insulin resistance, Polyclonal Hypogamma Globulinemia, Factor V leiden, sleep apnea, A-fib, Aortic Valve Prolapse, Breast Cx 11 years ago. Current medications included: Coumadin, Urocit (for kidney stones), Coreg, Cozaar, Lipitor, Celebrex, Celexa, Actos, Byetta, Growth hormone, Ultram.
Clinical exam revealed discolored #22, no response to cold, slight percussion tenderness, negative palpation tenderness tooth #22. Adjacent teeth responded WNL to all pulp vitality tests. Patient has no restorations present on #22. She did undergo orthodontic therapy in her mid-40’s to upright and rotate #22 into its current location. Radiographs revealed that the coronal 1/3 of the pulp chamber tooth #22 was patent, however, the remaining canal was completely obliterated radiographically. This was an unusual presentation due to the fact that teeth will undergo calcification from the coronal extent of the tooth and typically, the apex is somewhat more visible radiographically.
I welcome any questions and/or comments. Thanks again for you continued confidence in my practice!