Case of the Month May 2010

by todd May 12, 2010 Case of the Month 0 comments

Hello again. My apologies for not keeping up with this Blog due to my injury. We are back to full speed now so here is May’s COTM.

Patient is a 47 y.o male with CC of bump on his gums for several months. He is asymptomatic and pain is 0/10 currently.
Medical history: He takes Tramadol and Darvocet for chronic back pain.
Clinical exam reveals: Sinus tract stoma present facial to #12, PFM crns #13,14. Large restorations present #12,15.
Pulp tests reveal: Normal response to cold #12(although slightly exaggerated, and #15. No response to cold #13,14.
Radiographs reveal normal periradicular tissues #12,13. Diffuse RL lesion associated with the MB root #14. Previous RCT #13,14.
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Lesion was traced with GP point

Treatment options were discussed with patient including no treatment, extraction and prosthetic replacement, non-surgical retreatment, or surgical treatment. I recommended non-surgical retreatment of the case.
Considerations for non-surgical retreatment included short obturation of MB, Palatal and DB canals which were probably blocked with dentinal debris from previous treatment, curved mesial root which could also be perforated or canal transported while trying to instrument canal to length, and fracture of porcelain crn.
Here is the result from the retreatment: Due to the complexity of the case. Treatment was performed in 2 appointments.

As some of you may have noticed, RCT was done #12 in the interim as well. This is because the patient returned with moderate pain. Remember, that from the initial exam he had a slightly exaggerated response to cold. It turns out that this tooth underwent irreversible pulpitis in between the appointments for #14.