Skip to content

Case Challenge July 2022

By Dr. Derek Peek

A 69-year-old female presented for a follow up on tooth #5. She states that she has a bump on her gums after the crown on #4 was placed in the undergraduate clinic 2 months ago. She says it hurts to chew and that the crown on #5 doesn’t seem to fit right. There is localized gingival swelling mesial to #5 as well as the presence of a sinus tract.

Med Hx: ASA II. Well controlled Hypertension and Hyperlipidemia.

Rx: Aspirin 81mg, Calcium, Pravastatin, Amlodipine, HCTZ, Buspirone HCL.

Allergies: NKDA

Hx of Current Illness: The initial treatment on #5 was completed in 2 appointments in the undergraduate clinic 9 months ago followed by immediate crown placement. The pre-op diagnosis was Symptomatic irreversible pulpitis with Symptomatic apical periodontitis. Her original chief complaint was to cold and chewing that was resolved with the root canal treatment.

Radiograph assessment: Obturation appears to be short in the palatal canal. PDL and lamina dura present at both apices. Gutta percha traces to the PARL on the mesial surface of the root on #5. The crown margins and contours are well approximated to the tooth structure. No recurrent caries present. The crown on #5 is loose.

Probing depth: 3-4mm circumferentially with isolated 12mm mesial probing depth on #5.

Current Diagnosis: Previously treated with Chronic apical abscess

Case Challenge Poll July 2022

What is the etiology of the lateral PARL on #5?

We'll reveal the best answer in a future edition of The Paper Point!

In the February edition of The Paper Point, we featured a Case Challenge poll question, and now have the best answer to reveal below!:

What would be your primary treatment choice?

 
 
 
 
 
Regeneration was attempted at this point strictly following the protocols laid by the AAE. The first step was repeated twice as there was purulent exudate after the first step of regeneration. Patient showed signs of healing and the purulent exudate stopped and only after the regenerative endodontics was completed in four appointments in a four-month period.

Congratulations to the 44 percent of respondents who chose this best answer: A, Regenerative Endodontics!