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4 year follow-up of a trauma
The opinions and photographs within this web page are not ours. Authors have been credited
for the individual posts where they are. - Photos courtesy of Marga - www.rxroots.com


From: Marga Ree
To: ROOTS
Sent: Tuesday, July 26, 2005 01:11 AM
Subject: [roots] 4 year follow-up of a trauma

This patient was referred to me 4 years ago, after he sustained a 
dental trauma. At that time he was 11 years old. Tooth # 11: 
horizontal root fracture, tooth # 21 AP with a sinus tract, and 
a wide irregular pulp canal space, due to a resorption process.

Thermal tests on tooth # 11 WNL, no sensitivity on percussion and 
palpation. I decided to monitor # 11, the only therapy consisted 
of a restoration of the crown fracture with an adhesive composite.

Upon access of # 21, there appeared to be a perforation to the distal 
and the mesial, due to the resorptive process. Ca(OH)2 for a few weeks, 
application of MTA in the apical part, composite in the middle and 
coronal part of the canal to reinforce the tooth, and a cosmetic 
composite build-up. The sinus tract had almost disappeared at the 
time I finished the case, see clinical pics.

16 months follow-up showed PCO in # 11. The tooth didn't respond to 
thermal tests and EPT. However, no discoloration of the clinical 
crown. # 21 was doing well, no complaints, sinus tract disappeared completely.

Today I received the rad of the referring dentist of the 4 year 
follow-up. I didn't see the patient myself. The PCO has progressed, 
but, according to the referring dentist, still no signs or symptoms. 
I do see a kind of a radiolucent area at the obliterated root, 
apically and coronally of the fracture level, what do you think? 
Or is it just my imagination? - Marga



I believe I see what you are seeing, but I’m attributing it to normal radiographic changes in a tooth undergoing orthodontic traction. I think I’d be of the mindset to monitor it some more - gary Marga, did the patient have orthodontic treatment in the meantime? - Jörg It will be interesting to see if there is any distraction of the apical fragment during the orthodontic treatment - Stephen. Dear Marga, mesial and coronally of the fracture line it seems to me if there is some area of external resorption - Bart I do see this area as well---a rather large, ovoid area? if we are talking about the same area, i'm not sure what to make of it either, sorry no help, - Kendel Marga it does look like a radiolucent area apically and coronally to the fracture line.............................. One question regd. packing the canal space with composite ......... .........What bond do u prefer........ I mean which generation and what type of composite do you use? Is packable posterior composite a choice and are you depth curing the composite ? - Sachin Sachin, A packable composite is way too stiff to apply in a canal space. I prefer a self cure build-up material with the right consistency to put it in a needle tube and squirt it in the canal space, for me LuxaCore does the job. LuxaCore is also available in a dual cure version. The reason for me to choose a self-cure, is because their relatively slow-setting rate are thought to provide flow to relieve the shrinkage stress developed during setting. For bonding material, see attached pics - Marga

I use gold Build It for this, Marga. It leaves a soft back ground for all porcelain crowns and is easily identifiable as not being tooth. Guy Marga: Do you have any concerns that by placing a composite post/core buildup of that magnitude that you may be committing the patient to surgery in case of retreatment as access may be difficult? - Gary Gary, In this case I placed a fiber post in the bulk of composite. I do this amongst others to facilitate retreatment if necessary. You can remove a fiber post quite easily, provided you have a scope and can see what you are doing. Another advantage is that by placing the post, you're reducing the mass of composite and therefore reducing the polymerization shrinkage. It also gives the build-up more stiffness. These are some of the reasons that I usually insert passively a fiber post after making a build-up of composite of that magnitude - Marga Somehow I couldn’t see you cramming composite 2/3 the length of a root, but somehow I missed the fiber post part. Sorry about that - Gary It is difficult, if not impossible to see, due to lack of radiopacity of the post. I found your remarks very adequate - Marga
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