{"id":20815,"date":"2022-02-24T09:00:42","date_gmt":"2022-02-24T15:00:42","guid":{"rendered":"https:\/\/www.aae.org\/specialty\/?p=20815"},"modified":"2022-07-22T11:55:26","modified_gmt":"2022-07-22T16:55:26","slug":"case-challenge-5","status":"publish","type":"post","link":"https:\/\/www.aae.org\/specialty\/case-challenge-5\/","title":{"rendered":"Case Challenge"},"content":{"rendered":"\n\n\t<p><em>By Mahua Bose Pillai, DDS, MMSc, BDS, MDS<\/em><\/p>\n<p>A 16-year-old Hispanic male presented with his mother with the chief complaint of &#8220;I have pus coming out of my front tooth&#8221;. The patient reported to have started his orthodontic treatment one year ago and within two months of that he started having spontaneous pain on #10, especially when he is in a lying down position. The pain subsided at about the six months period, at which point he noticed a sinus tract apical to #10.<\/p>\n<p>Med Hx: Patient reports no notable medical conditions on review of systems. Patient reports taking no medications and has no known drug allergies.<\/p>\nClinical Evaluation: A sinus tract is noted on the palatal aspect. The orthodontic bracket on #10 was broken and #10 had no mobility. He had a large \ufb02uctuant swelling in the palate 5cm x 4cm and when he pressed on it pus oozed out of the buccal sulcus on #10.<br \/>\n<img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/www.aae.org\/specialty\/wp-content\/uploads\/sites\/2\/2022\/02\/Figure1-1.jpg\" alt=\"\" width=\"393\" height=\"583\" \/><br \/>\n<img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/www.aae.org\/specialty\/wp-content\/uploads\/sites\/2\/2022\/02\/Figure2.jpg\" alt=\"\" width=\"928\" height=\"645\" \/>\n<p><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/www.aae.org\/specialty\/wp-content\/uploads\/sites\/2\/2022\/02\/Figure3.jpg\" alt=\"\" width=\"673\" height=\"679\" \/><\/p>\n<img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/www.aae.org\/specialty\/wp-content\/uploads\/sites\/2\/2022\/02\/Figure4.jpg\" alt=\"\" width=\"670\" height=\"456\" \/>Radiographic Interpretation<br \/>\n#10 has Dens Invaginatus (Oehler&#8217;s type I) with a large PARL surrounding #9,10,11. CBCT shows complete loss of palatal cortical plate.\n<p><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/www.aae.org\/specialty\/wp-content\/uploads\/sites\/2\/2022\/02\/Figure5.jpg\" alt=\"\" width=\"770\" height=\"311\" \/>Diagnosis #10 &#8211; Pulpal Necrosis with Chronic Apical Abscess.<\/p>\n\t<p>Stay tuned! We&#8217;ll reveal the treatment choice used &#8212; plus, more details on the progress of this case and another Challenge Question &#8212; in a future issue of <em>The Paper Point<\/em>.<\/p>\n\t<p>In the <a href=\"https:\/\/www.aae.org\/specialty\/paperpoint\/case-challenge-4\/\" target=\"_blank\" rel=\"noopener\">January 2022 <em>Case Challenge<\/em><\/a>, we posted a challenge question; and now have the answer below!:<\/p>\n<table>\n<thead>\n<tr>\n<th id=\"field_id-1\" scope=\"col\">According to Tamse, Fuss and Lustig and Kaplavi&#8217;s 1999 evaluation of vertical root fractures in endodontically treated teeth, which of the following was NOT determined to be a predictor of the presence of a VRF?<\/th>\n<th id=\"column_selector\" scope=\"col\"><\/th>\n<\/tr>\n<\/thead>\n<\/table>\n<ul>\n<li>\n<label id=\"label_52_1_0\" for=\"choice_52_1_0\">A. Lateral radiolucency (aka &#8216;J-shaped lesion&#8217;)<\/label>\n<\/li>\n<li>\n<label id=\"label_52_1_0\" for=\"choice_52_1_0\"><\/label><label id=\"label_52_1_1\" for=\"choice_52_1_1\">B. Non-surgical Endodontic retreatment<\/label>\n<\/li>\n<li>\n<label id=\"label_52_1_1\" for=\"choice_52_1_1\"><\/label><label id=\"label_52_1_2\" for=\"choice_52_1_2\">C. Sinus tract at gingival margin<\/label>\n<\/li>\n<li>\n<label id=\"label_52_1_2\" for=\"choice_52_1_2\"><\/label><label id=\"label_52_1_3\" for=\"choice_52_1_3\">D. Solitary buccal periodontal pocket<\/label>\n<\/li>\n<\/ul>\n<strong>Answer: B.<br \/>\n47 percent of respondents chose this correct answer; way to go!<\/strong>\n\n","protected":false},"excerpt":{"rendered":"<p>By Mahua Bose Pillai, DDS, MMSc, BDS, MDS A 16-year-old Hispanic male presented with his mother with the chief complaint of &#8220;I have pus coming out of my front tooth&#8221;.&hellip;<\/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":[266],"tags":[],"feature":[236],"class_list":["post-20815","post","type-post","status-publish","format-standard","hentry","category-uncategorized","feature-paperpoint"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.1.1 - 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