{"id":13847,"date":"2019-11-25T08:00:38","date_gmt":"2019-11-25T14:00:38","guid":{"rendered":"https:\/\/www.aae.org\/specialty\/?p=13847"},"modified":"2019-11-29T10:00:05","modified_gmt":"2019-11-29T16:00:05","slug":"case-challenge-3","status":"publish","type":"post","link":"https:\/\/www.aae.org\/specialty\/case-challenge-3\/","title":{"rendered":"Case Challenge"},"content":{"rendered":"\n\t<p><em>By Brad Gettleman, D.D.S., M.S.<\/em><\/p>\n<p>A 58-year-old Caucasian female presents for evaluation of tooth #30. The patient states, \u201cmy hygienist found decay last week during my teeth cleaning\u201d. She is completely asymptomatic and the tooth responds normally to all pulp vitality and periradicular tests. Periodontal probings are all 3 mm or less, and occlusion is not an issue. Her restorative dentist states that all previous periapical radiographs look virtually identical to the one taken at the consultation appointment. Radiographic (PA and CBCT) and clinical assessment reveal (external cervical resorption) ECR.<\/p>\n<p>Historically, clinicians have attempted treatment on many of these cases with limited success, mainly due to not having accurate knowledge of the extent of the defect. However, CBCTs have opened our eyes to the quantity of tooth structure resorbed by these lesions, and the importance of using this technology for diagnosis of root resorption.<\/p>\n<p>Due to the location of this defect and the concerns of either a possibility of bone loss secondary to treatment or periodically following up with clinical and radiographic examination, the decision was made to extract the tooth, as unexpected bone loss could leave the site less predictable for an implant.<\/p>\n<p>Vitals:<\/p>\n<p>Blood Pressure: 134\/88<\/p>\n<p>Heart Rate: 68<\/p>\n\t\t\t\t<img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/www.aae.org\/specialty\/wp-content\/uploads\/sites\/2\/2019\/11\/X810400102-295x190.jpg\" alt=\"X810400102\" height=\"190\" width=\"295\" title=\"X810400102\" \/>\n\t\t\t\t<a href=\"https:\/\/www.aae.org\/specialty\/2019\/11\/25\/case-challenge-3\/ct2\/\" target=\"_blank\" rel=\"noopener noreferrer\">\n\t\t\t\t<img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/www.aae.org\/specialty\/wp-content\/uploads\/sites\/2\/2019\/11\/ct2-copy-295x190.jpg\" alt=\"ct2 copy\" height=\"190\" width=\"295\" title=\"ct2 copy\" \/>\n\t\t\t\t<\/a>\n\t<p>Poll: Was extraction the best option?<\/p>\n\t<p><em>Dr. Brad Gettleman is board liaison for the AAE\u2019s Resident and New Practitioner Committee.<\/em><\/p>\n\t<p>In the <a href=\"https:\/\/www.aae.org\/specialty\/2019\/07\/25\/case-challenge-2-2\/\" target=\"_blank\" rel=\"noopener noreferrer\">July 2019 Case Challenge<\/a>, we posted a poll; and now have the results below:<\/p>\n<ul id=\"input_23_1\">\n<li>\n<ul id=\"input_31_1\">\n<li>What follow-up treatment approach is advisable?<br \/>\nA. Continue to monitor, have patient return for 12-month recall <strong>14%\u2028<\/strong><br \/>\nB. Non-surgical retreatment <strong>76%\u2028<\/strong><br \/>\nC. Apical microsurgery <strong>6%\u2028<\/strong><br \/>\nD. Referral to oral medicine <strong>1%\u2028<\/strong><br \/>\nE. It&#8217;s a cracked tooth; extract. <strong>3%<\/strong><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p>Best answer: <b>B. <\/b>The author\u00a0ended up performing a non-surgical retreatment on no. 15. She found a mid-root split in the M root. She treated the tooth in two appointments just to see if her symptoms subsided. Patient reported all symptoms resolved as soon as she retreated the tooth.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>A 58-year-old Caucasian female presents for evaluation of tooth # 30.  The patient states, \u201cmy hygienist found decay last week during my teeth cleaning\u201d.  She is completely asymptomatic and the tooth responds normally to all pulp vitality and periradicular tests.  <\/p>\n","protected":false},"author":12,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"content-type":"","_relevanssi_hide_post":"","_relevanssi_hide_content":"","_relevanssi_pin_for_all":"","_relevanssi_pin_keywords":"","_relevanssi_unpin_keywords":"","_relevanssi_related_keywords":"","_relevanssi_related_include_ids":"","_relevanssi_related_exclude_ids":"","_relevanssi_related_no_append":"","_relevanssi_related_not_related":"","_relevanssi_related_posts":"","_relevanssi_noindex_reason":"","footnotes":""},"categories":[32],"tags":[],"feature":[236],"class_list":["post-13847","post","type-post","status-publish","format-standard","hentry","category-resorption","feature-paperpoint"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.1.1 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Case Challenge - American Association of Endodontists<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.aae.org\/specialty\/case-challenge-3\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Case Challenge - American Association of Endodontists\" \/>\n<meta property=\"og:description\" content=\"A 58-year-old Caucasian female presents for evaluation of tooth # 30. The patient states, \u201cmy hygienist found decay last week during my teeth cleaning\u201d. She is completely asymptomatic and the tooth responds normally to all pulp vitality and periradicular tests.\" \/>\n<meta property=\"og:url\" content=\"https:\/\/www.aae.org\/specialty\/case-challenge-3\/\" \/>\n<meta property=\"og:site_name\" content=\"American Association of Endodontists\" \/>\n<meta property=\"article:publisher\" content=\"https:\/\/www.facebook.com\/endodontists\" \/>\n<meta property=\"article:published_time\" content=\"2019-11-25T14:00:38+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2019-11-29T16:00:05+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/www.aae.org\/specialty\/wp-content\/uploads\/sites\/2\/2019\/11\/X810400102-295x190.jpg\" \/>\n<meta name=\"author\" content=\"Elisabeth Lisican\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:creator\" content=\"@savingyourteeth\" \/>\n<meta name=\"twitter:site\" content=\"@savingyourteeth\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"Elisabeth Lisican\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"2 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":\"Article\",\"@id\":\"https:\/\/www.aae.org\/specialty\/case-challenge-3\/#article\",\"isPartOf\":{\"@id\":\"https:\/\/www.aae.org\/specialty\/case-challenge-3\/\"},\"author\":{\"name\":\"Elisabeth Lisican\",\"@id\":\"https:\/\/www.aae.org\/specialty\/#\/schema\/person\/db2d09ae5a4e55e3f493d0bdb744a5fa\"},\"headline\":\"Case Challenge\",\"datePublished\":\"2019-11-25T14:00:38+00:00\",\"dateModified\":\"2019-11-29T16:00:05+00:00\",\"mainEntityOfPage\":{\"@id\":\"https:\/\/www.aae.org\/specialty\/case-challenge-3\/\"},\"wordCount\":320,\"publisher\":{\"@id\":\"https:\/\/www.aae.org\/specialty\/#organization\"},\"image\":{\"@id\":\"https:\/\/www.aae.org\/specialty\/case-challenge-3\/#primaryimage\"},\"thumbnailUrl\":\"https:\/\/www.aae.org\/specialty\/wp-content\/uploads\/sites\/2\/2019\/11\/X810400102-295x190.jpg\",\"articleSection\":[\"Resorption\"],\"inLanguage\":\"en-US\"},{\"@type\":\"WebPage\",\"@id\":\"https:\/\/www.aae.org\/specialty\/case-challenge-3\/\",\"url\":\"https:\/\/www.aae.org\/specialty\/case-challenge-3\/\",\"name\":\"Case Challenge - 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