Retained Primary Tooth Defect: UPDATE

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Posted on By Ben Lashley In Bone Grafting

I just replied to my own case but will re post for Photos. 16 year old female with retained primary tooth ankylosed to the floor of the palate. Surgical intervention is in previous post. 5 months post op reveals imporved tissue height nearly to normal on palatal papilla but clear buccal defect still present. 6 mm apical to the CEJ there is a floor to the soft tissue but still enough defect to harbor food. Root surfaces are still exposed on mesial of 3 and distal of 4 to the tune of about 4-6 mm apical of the CEJ. Appears there is adequate soft tissue to achieve primary closure with a CT graft should bone augmentation be warrented. At this point it feels like a zero wall defect as I am unsure about the amount of buccal or palatal wall there is and I know there is minimal or no bone on the surfaces of the teeth. Advice is welcomed.

Ben Lashley




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7 Comments

Ben; 1st thing, this is a very tough situation on a young patient. I would suggest this be sent to a Periodontist and have a CBCT taken and evaluated. After review of CBCT, a plan of whether or not these teeth are candidates for periodontal GTR procedures to minimize the extent of this defect. It is possible that one or both of these teeth have lost too much PDL and attachment and with little regenerative potential due o lack of walls, extraction may be needed. Good luck Dr. Salama


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Thank you Dr Salama! I can take a new scan for evaluation here in our office. My nearest Periodontist is 300 miles from our town here in North Platte, NE. Likely Lincoln where the University is or the Denver area. I didn't load a new pan on this site due to size. I can take another one and send it to someone for additional review or could send it Dicom to you or anyone for review. I am pretty well versed in GTR procedures which is how I received the case in the first place but I also agree this is a very complicated case. I also know it will take some convincing to motivate the family to drive to Lincoln multiple times for consult and subsequent treatment due to finances. I agree though, I am not very excited about the success of the procedure due to the lack of PDL or anything else bone wise with what is left. I had a brush with this case several years ago and recommended treatment before the other teeth erupted back then. hind sight is always better. Right now I also have the orthodontist in a holding pattern to see where we go next. That seems to lead us to loss of two teeth and orthodontic movement of second and third molars as the option if GTR is unsuccessful? Should I involve the University if the patients are willing? Thanks for the thoughts. Ben


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A cracked tooth is a tooth in which there exists a partial or completes fracture of a molar perhaps due to pointy, protruding maxillary molar palatal.


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I think that is little rigenerative potential for a GBR procedure. The lost of PDL and attachment is very important, consider the age of the patient.
The distance of the premolar and molar don't help you.
The extraction of one of this tooth is the best solution.
Which???


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UPDATE: A new 3D scan reveled no new bone formation on either teeth and still no buccal plate. After conference with my treating orthodontist we decided it could be treated with extraction of both teeth. Number two could be moved forward to the number 3 spot and then it would be assumed that we would at least have a 3 and perhaps 4 wall defect for future implant placement in the "premolar" area as the bone would follow the teeth orthodonticly. I have also sent all the information, photographs and radiographs to a periodontist that I respect very much. He is going to attempt GBR first with a Dr. Chaos technique and emdogain. We will follow it for a year before anything radical orthodonictly as described above. Both seem to be long shots but hopefully mother nature and youth will be on our side. Thank you all for your input! Ben


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Ben; I like the idea of moving #2 into the #3 position. You may want to consider intentional rotation of tooth #4 before you consider extraction. You could rotate the labial or palatal attachment and bone INTO the defect and it would support your wire during orthodontic traction of #2 into #3 position. GTR will provide minimal success....good luck Dr. Salama


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Thank you Dr Salama! I will pass these thoughts on to the other team members in the case. It may be a while but I will let you all know the outcome and include post photos. Thanks again for the responses. Ben


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