Severe gingival inflammation: Tooth #6 and #11 - Courtesy ROOTS
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From: Terry Pannkuk
Sent: Wednesday, September 23, 2009 9:52 PM
Subject: [roots] Tale of Two Cities-Quiz
How about this consult from yesterday.
Patient: 57 year old male
Dental History: adult ortho, Tooth #2 had previous resorption extensively involving the distal aspect,
it cracked, and was extracted in 2001.
This is specifically for Guy who recommended moving the severely tilted lower bicuspid through a mile
of 66 year old bone. 66 years old isn't necessarily old but the bone sure gets hard
(especially in the cranium :):):))
I'm not dead set against an ortho plan; I just wouldn't want to aggressively sell it based upon the
incidence of ECIR and association with adult ortho I constantly see.
Here's a good consult I saw yesterday. I'm collecting these as treatment planning exercises for
postgrad students as I'm starting to teach at USC and UCSF.
Tooth #6: 5-6mm pockets circumferentially with a radiographically visible osseous crater, severe
gingival inflammation. pulp tested necrotic, and a lingual crater can be probed on the lingual.
There is Class 1 mobility so it isn't ankylosed, no percussion sensitivity or other symptoms.
Tooth #11: Normal perio findings, slight gingival inflammation upon probing especially the lingual aspect.
I didn't probe aggressively but suspect that if you really jammed an explorer deep into the lingual sulcus
area you might be able to penetrate a root crater. Tooth tested vital, no symptoms, no percussion, and
all other clinical findings were within normal limits.
Dx #'s 6 and 11 ? Treatment plan? - Terry
Canines were impacted and pulled down during ortho--one pulp didn't survive - B M Chauvin