55 years old Female complaining of pain in Tooth no. #21
-Percussion : +++
-Palpation : +++
-Swelling : + ( slight diffuse swelling)
-Probing : all within normal except MB (7mm) & ML (7mm) ? I suspected a crack at this time ??
-CO2 test :- -ve
-Mobility grade III
The tooth is intact with no previous history of trauma or any dental procedure except for office bleaching 4 years ago??
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Medical history :
-Diabetic ( controlled with tablets)
-Mild hypertension ( controlled with dietary advice only no medication)
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Diagnosis and Treatment Planning:
Many things came up into my mind at that time ??
1- is it primary endo secondary perio
2- is it primary perio secondary endo
3- is it because of a crack ( if there is a crack ?)
4- shall I go for R.C.T first or exploratory surgery?
The patient wanted to extract the tooth ??
I refused & I told her " let me try to save the tooth"
she accepted my proposal & i start to think which direction should i start ( i.e exploratory surgery first or R.C.T )?? I decided to do R.C.T first
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Treatment:
First, thing I did is anaesthesia then rubber dam
Access cavity was done (notice the access there was no bleeding from pulp which confirm my CO2 test i.e necrotic pulp)
Hand preparation
Obturation(lateral condensation) is done with master cone size 55
After That, I opened a flap ( papilla preservation flap )
Please notice the brown spots along the root surface which was coverd by calculus like deposite ( unfortunately i did not take a picture of the calculus on the root surface )
I started to clean the area( the problem here is that the tooth is moving while I am planing the root thus, i decided to splint the tooth at this stage )
I checked for crack with methylene blue and I found no crack
So I decided to complete the root planing followed by bone augmentation
then I placed Guided Tissue Membrane and Sutured (vertical mattress)
Antibiotic with mouth wash was prescribed.
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