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What happened with the tooth and can we keep the hopeless tooth?
Posted on 08.12.2012 06:28 AM
By TRI DUNG NGUYEN
In Periodontics
Dear my nice colleagues,
Today, my patient comes clinic because she's had gum swollen and painful for about 02 months. The position of the pain is the palatal gum of tooth 17 (right upper second molar).
When using the probe, I'm very surprised because the very deep pocket at mesial and palatal side around tooth 17 (the probe can reach the apex easily). The tooth has connected with 16 by 02 gold crowns. However now, I can feel it's loosing. I put gutta percha cone and take the Xray to confirm the pocket depth. I detect the distal side of this tooth is the impacted wisdom! Generally, in my opinion, there's only buccal wall is still OK, then, this tooth should be extracted as soon as possible. My question is what is the problem (reason) for bone loss in this case. 05 years ago, this tooth was healthy, no pocket when she first came my clinic and took panoramic film. She hasn't complained about this tooth until about 02 months ago. I'm affraid about occlusion trauma, but 16 and 17 are connected together and I don't see any problem of occlusion when checking with articulating paper. Every year she also comes for teeth cleaning. Maybe my hygienist doesn't check the pocket well and it's my clinic's mistake.
The next question is that it is really hopeless tooth and need to be removed, or is there any technique to save this tooth?
The last question is in case of extraction, should I use allo bone and membrane to graft in the socket (socket preservation) immediately to preserve the bone (but with the risk of infection), or I should take out the tooth, let the socket heal naturally, stop the infection and start socket preservation or implant placement 02 or 04 months later?
Thank you very much for your help.
Best regards.
Tri Dung.
5 Comments
Pantelis Bochlogyros says on 08.12.2012 08:45 AM
Dear DrTRI DUNG NGUYEN, seems to me a good idea to focus on saving 16 by extracting 17 and 18 too.Possible causes: Short crowns with no anatomical shape, wide interproximal contact surface , difficult hygiene practice with interproximal brushes and misdiagnosed chronic undermining lesion to the area.I believe that such lesions can easily skip x ray examination especially if they are localized. They ran undiagnosed through time till they come up with major symptoms.In any case a CBCT will help .You may also extract 17 leaving intact the prosthesis and having 17 as a chandelier. Dr.P.Bochlogyros
Maurice Salama says on 08.12.2012 09:33 AM
The biggest diagnostic issue here is whether this is a perio or endo lesion?? If endo, perhaps 17 is salvageable. If perio-endo that most likely it is hopeless. Perform test cavity through occlusal of 17 to test pulp vitality.
good luck
Dr. Salama
omid moghaddas says on 08.12.2012 03:04 PM
i think its a perio-endo lesion ,but you need to do a vitality test to be sure,and in the case of perio endo lesion it is hopeless,the tooth seems to have a chronic tract.i am agree with dr salama.good luck
Lotta Carmelo860 says on 08.14.2012 06:53 AM
In consideration of the quality an quantity of the bone that is present in the other theet, I thing that the patinet in not a periondontal case. Probabily the initial cause is a endodontic lesion (test of vitality can confirm, or not).
After because the problem is'nt identificate for a long time, it is became perio lesion. The probing depth is the "fistola for abscess. Befor treat le endo lesion, don't tacc the root surfaces with instrument for scaling, waith one/ two mounth and controll. If you are lucy, and have made a good endo treatment the result is ok. Dr Lotta Carmelo, Padova.ITALY
TRI DUNG NGUYEN says on 08.17.2012 02:33 AM
Dear my all colleagues,
Thank you very much for your comments.
This morning, I see my patient and she agrees to extract this tooth. After removing the crown, there's a big cavity under the crown, the nerve was died and very bad smell. But when I try to clean the root canal, I see the water come out through the gingival pocket. That means it's a endo-perio leision. So I take out this tooth, also the impacted wisdom. I'll wait 03 months and continue an implant treatment for this tooth.
I hope it's a good experience for me to take care my patients in future.
Best regards.
Dr. Tri Dung.