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A forty five-year-old male affected person has beforehand offered to our workplace in 2015 with the chief criticism of getting a gap behind his proper maxillary central incisor (Determine A). The affected person acknowledged he had trauma to the tooth at age 18 and that the tooth was repositioned by a dentist.
The affected person had endodontic remedy began on tooth #8 six years previous to that go to, however by no means returned for completion. The momentary restoration dislodging from the palatal facet of the tooth prompted the affected person to return in for remedy. Cotton was current within the canal (Determine B).
Preliminary Diagnostics and Therapy
Periapical radiographs of # 8 have been taken and different than slight discoloration and a minor facial swelling, no discomfort was reported. A gingival abscess was traced to mid-level of tooth radiographically (Determine C).
At this level, the endodontic process for tooth # 8 was accomplished as much as the purpose the place we believed the root to finish (Determine D) noting that there was a attainable fracture additional apical to that time. A lingual composite was positioned on # 8. The affected person was made conscious that the prognosis for the tooth was guarded.
The affected person didn’t return for the next follow-up appointment that was scheduled. Further makes an attempt to get the affected person to return within the following yr have been unsuccessful.
Six Years Later
Six years after the preliminary go to, in February of 2022, the affected person returned with the chief criticism of, “My entrance tooth is painful, it strikes, it’s discolored, and generally it has an abscess”. The examination revealed that tooth #8 had grade three mobility, with suppuration emanating from the sulcus upon palpation of the gingiva. The periapical radiograph confirmed resorption of the foundation on the level the place the gutta percha fill of the foundation canal remedy ended (Determine E).
The apical fracture of #8 was extra clearly famous on this picture. The apical portion appeared ankylosed. The preliminary evaluation based mostly on the 2D photographs was to extract and consider for a bone graft/membrane placement, enable three to 4 months of therapeutic time, after which reassess for implant placement. The affected person inquired if there was any likelihood for the implant to be positioned at the time of extraction and if the fractured a part of the foundation would be eliminated.
3D imaging was used to find out the suitable remedy plan. A DEXIS OP 3D 5×5 cm FOV with the endodontic decision protocol (95 kVp, 2mA, 80 μm) was taken to see the bone sample and periodontal ligament house surrounding the broken tooth. We have been capable of visualize the true dimension of the apical fracture for tooth # 8, in addition to the complete dimensions of the bone (Determine F).
3D visualization enabled me to see not solely the damaged apical facet of the tooth but additionally a small breakaway of a chunk of the root nearing the palate within the cross-sectional view (Determine G).
This larger diagnostic energy permits me present my sufferers what is happening underneath the floor; in the end leading to acceptance of the remedy plan (Determine H).
Therapy Planning in 3D
3D imaging information offers a stage of readability past the constraints of 2D intra and extra-oral imaging. It permits us to evaluate if the standard and amount of bone was viable for dental implant placement. With the power to view the affected person’s #8 in three dimensions, we have been capable of make a number of definitive diagnoses. The apical fracture is sizeable, but it surely doesn’t seem like as ankylosed as I initially hypothesized. The suppuration appeared to emanate from the mid root space, with no seen pathology across the apical fracture of the foundation (Determine I). In consequence, we proposed rapid placement of an implant within the web site at #8.
If we’re profitable in eradicating the foundation tip in an atraumatic style and may debride the world of all infectious tissue and place a direct implant. As soon as completed, we’d create a short lived utilizing the coronal portion of affected person’s current tooth and apply a lingual splint that may bond the coronal of #8 to the adjoining tooth (the affected person has a category III chunk). After three to 4 months of osseointegration, restoration for #8 would begin.
On this medical case, though the apical fracture of #8 was seen on the 2D x-rays, the DEXIS OP 3D gave diagnostic readability on the affected person’s failing tooth.
The affected person was uncertain about tips on how to proceed, however after reviewing the scan and discussing the potential of rapid placement of an implant, the affected person agreed to maneuver ahead with the remedy plan.
If we’re certainly capable of carry out rapid placement, this method would enable for a streamlined surgical expertise, a shorter remedy time and lowered time with the momentary tooth by months.
Study extra about DEXIS OP 3D and the way it can handle your superior dental imaging wants right here: https://www.pattersondental.com/equipment-technology/digital-imaging/extraoral/dexis-op-3d
About Dr. Gaur
Dr. Raj Gaur attended Binghamton College, the place he obtained a Bachelor of Science diploma in Biology. After graduating from the New Jersey Dental Faculty on the College of Drugs and Dentistry, Dr. Gaur enrolled in a Common Dental Residency program at Jamaica Hospital Medical Heart in Jamaica, New York.
Dr. Gaur started personal follow within the Triboro space of New York in 2007. In 2012, he bought a non-public follow on Lengthy Island, which now serves as a common and pediatric dentistry workplace.
Whereas not at work, Dr. Gaur enjoys sustaining an lively life-style, touring and spending time along with his spouse and three youngsters.