{"id":8961,"date":"2018-08-07T09:50:34","date_gmt":"2018-08-07T14:50:34","guid":{"rendered":"https:\/\/www.aae.org\/specialty\/?p=8961"},"modified":"2019-11-26T19:04:21","modified_gmt":"2019-11-27T01:04:21","slug":"case-challenge-august-2018","status":"publish","type":"post","link":"https:\/\/www.aae.org\/specialty\/case-challenge-august-2018\/","title":{"rendered":"Case Challenge: August 2018"},"content":{"rendered":"\n\t<p><em>By Mary Um, D.M.D.<\/em><\/p>\n\t<p>A 65-year-old white female presented for six-month follow-up after non-surgical root canal treatment on #14 completed by an endodontic resident. The patient reported unremitting pain (8\/10) that occasionally worsens of its own accord. She also noted localized swelling of the gingival tissue and pain with flossing around tooth #14 several times in the last three months.<\/p>\n<p>Med Hx: ASA II: hypothyroidism and fibromyalgia. She reports last flare-up six years ago. Review of systems was otherwise unremarkable.<\/p>\n<p>Surgical Hx: Appendectomy (1962), C-Section (1976), Tubal ligation (1982), Tonsillectomy (1992), Hysterectomy (2000), Cholecystectomy (2002).<\/p>\n<p>RX:\u00a0 Synthroid 175mcg 1\/day.<\/p>\n\t<script>\nvar gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),document.addEventListener(\"gform\/theme\/scripts_loaded\",function(){gform.themeScriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,themeScriptsLoaded:!1,isFormEditor:()=>\"function\"==typeof InitializeEditor,callIfLoaded:function(o){return!(!gform.domLoaded||!gform.scriptsLoaded||!gform.themeScriptsLoaded&&!gform.isFormEditor()||(gform.isFormEditor()&&console.warn(\"The use of gform.initializeOnLoaded() is deprecated in the form editor context and will be removed in Gravity Forms 3.1.\"),o(),0))},initializeOnLoaded:function(o){gform.callIfLoaded(o)||(document.addEventListener(\"gform_main_scripts_loaded\",()=>{gform.scriptsLoaded=!0,gform.callIfLoaded(o)}),document.addEventListener(\"gform\/theme\/scripts_loaded\",()=>{gform.themeScriptsLoaded=!0,gform.callIfLoaded(o)}),window.addEventListener(\"DOMContentLoaded\",()=>{gform.domLoaded=!0,gform.callIfLoaded(o)}))},hooks:{action:{},filter:{}},addAction:function(o,r,e,t){gform.addHook(\"action\",o,r,e,t)},addFilter:function(o,r,e,t){gform.addHook(\"filter\",o,r,e,t)},doAction:function(o){gform.doHook(\"action\",o,arguments)},applyFilters:function(o){return gform.doHook(\"filter\",o,arguments)},removeAction:function(o,r){gform.removeHook(\"action\",o,r)},removeFilter:function(o,r,e){gform.removeHook(\"filter\",o,r,e)},addHook:function(o,r,e,t,n){null==gform.hooks[o][r]&&(gform.hooks[o][r]=[]);var d=gform.hooks[o][r];null==n&&(n=r+\"_\"+d.length),gform.hooks[o][r].push({tag:n,callable:e,priority:t=null==t?10:t})},doHook:function(r,o,e){var t;if(e=Array.prototype.slice.call(e,1),null!=gform.hooks[r][o]&&((o=gform.hooks[r][o]).sort(function(o,r){return o.priority-r.priority}),o.forEach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==r?t.apply(null,e):e[0]=t.apply(null,e)})),\"filter\"==r)return e[0]},removeHook:function(o,r,t,n){var e;null!=gform.hooks[o][r]&&(e=(e=gform.hooks[o][r]).filter(function(o,r,e){return!!(null!=n&&n!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][r]=e)}});\n<\/script>\n\n                <div class='gf_browser_gecko gform_wrapper gform_legacy_markup_wrapper gform-theme--no-framework' data-form-theme='legacy' data-form-index='0' id='gform_wrapper_31' ><form method='post' enctype='multipart\/form-data'  id='gform_31'  action='\/specialty\/wp-json\/wp\/v2\/posts\/8961' data-formid='31' novalidate>\n                        <div class='gform-body gform_body'><ul id='gform_fields_31' class='gform_fields top_label form_sublabel_below description_below validation_below'><li id=\"field_31_1\" class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >What follow-up treatment approach is advisable?<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_31_1'>\n\t\t\t<li class='gchoice gchoice_31_1_0'>\n\t\t\t\t<input name='input_1' type='radio' value='A. Continue to monitor, have patient return for 12-month recall'  id='choice_31_1_0'    \/>\n\t\t\t\t<label for='choice_31_1_0' id='label_31_1_0' class='gform-field-label gform-field-label--type-inline'>A. Continue to monitor, have patient return for 12-month recall<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_31_1_1'>\n\t\t\t\t<input name='input_1' type='radio' value='B. Non-surgical retreatment'  id='choice_31_1_1'    \/>\n\t\t\t\t<label for='choice_31_1_1' id='label_31_1_1' class='gform-field-label gform-field-label--type-inline'>B. Non-surgical retreatment<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_31_1_2'>\n\t\t\t\t<input name='input_1' type='radio' value='C. Apical microsurgery'  id='choice_31_1_2'    \/>\n\t\t\t\t<label for='choice_31_1_2' id='label_31_1_2' class='gform-field-label gform-field-label--type-inline'>C. Apical microsurgery<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_31_1_3'>\n\t\t\t\t<input name='input_1' type='radio' value='D. Referral to oral medicine'  id='choice_31_1_3'    \/>\n\t\t\t\t<label for='choice_31_1_3' id='label_31_1_3' class='gform-field-label gform-field-label--type-inline'>D. Referral to oral medicine<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_31_1_4'>\n\t\t\t\t<input name='input_1' type='radio' value='E. It&#039;s a cracked tooth; extract.'  id='choice_31_1_4'    \/>\n\t\t\t\t<label for='choice_31_1_4' id='label_31_1_4' class='gform-field-label gform-field-label--type-inline'>E. 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Pre-op diagnosis was pulpal necrosis and symptomatic apical periodontitis. She had initially presented with mild intraoral swelling, which resolved after treatment. Patient reports that the nature of pain has changed since the root canal has been completed but has not resolved.\u00a0 Now, the pain has a radiating and pulsating quality.<\/p>\n<p>Radiographic assessment is suggestive of a 1-mm overextension of obturation material. A post-operative CBCT scan suggests that no separate MB2 canal is present. Post-operative imaging is suggestive of periapical bony healing around MB root of #14. However, the buccal plate remains perforated. No sinus membrane inflammation noted. Remainder of CBCT scan is unremarkable.<\/p>\n<table width=\"261\">\n<tbody>\n<tr>\n<th><\/th>\n<th>12<\/th>\n<th>14<\/th>\n<th>15<\/th>\n<\/tr>\n<tr>\n<td><strong>Cold<\/strong><\/td>\n<td>+<\/td>\n<td>&#8211;<\/td>\n<td>+<\/td>\n<\/tr>\n<tr>\n<td><strong>Palp<\/strong><\/td>\n<td>&#8211;<\/td>\n<td>+<\/td>\n<td>&#8211;<\/td>\n<\/tr>\n<tr>\n<td><strong>Perc<\/strong><\/td>\n<td>&#8211;<\/td>\n<td>+<\/td>\n<td>&#8211;<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>&nbsp;<\/p>\n<p>Probing depth: 3-4mm circumferentially.<\/p>\n\t<div id=\"attachment_8962\" style=\"width: 210px\" class=\"wp-caption alignnone\"><a href=\"wp-content\/uploads\/sites\/2\/2018\/08\/CaseChallenge_PreOp-200.png\" target=\"_blank\" rel=\"noopener noreferrer\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-8962\" src=\"wp-content\/uploads\/sites\/2\/2018\/08\/CaseChallenge_PreOp-200.png\" alt=\"\" width=\"200\" height=\"170\" \/><\/a><p id=\"caption-attachment-8962\" class=\"wp-caption-text\">Pre-op<\/p><\/div>\n\t<div id=\"attachment_8963\" style=\"width: 210px\" class=\"wp-caption alignnone\"><a href=\"https:\/\/www.aae.org\/specialty\/wp-content\/uploads\/sites\/2\/2018\/08\/CaseChallenge_PostOp-200.png\" target=\"_blank\" rel=\"noopener noreferrer\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-8963\" src=\"wp-content\/uploads\/sites\/2\/2018\/08\/CaseChallenge_PostOp-200.png\" alt=\"\" width=\"200\" height=\"158\" \/><\/a><p id=\"caption-attachment-8963\" class=\"wp-caption-text\">Post-op<\/p><\/div>\n\t<div id=\"attachment_8964\" style=\"width: 210px\" class=\"wp-caption alignnone\"><a href=\"https:\/\/www.aae.org\/specialty\/wp-content\/uploads\/sites\/2\/2018\/08\/CaseChallenge_6MonthRecall-200.png\" target=\"_blank\" rel=\"noopener noreferrer\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-8964\" src=\"https:\/\/www.aae.org\/specialty\/wp-content\/uploads\/sites\/2\/2018\/08\/CaseChallenge_6MonthRecall-200.png\" alt=\"\" width=\"200\" height=\"157\" \/><\/a><p id=\"caption-attachment-8964\" class=\"wp-caption-text\">6 Month Recall<\/p><\/div>\n\t<p>In the <em>December 2017 Case Challenge<\/em>, we posted a poll; and now have the results below:<\/p>\n<table>\n<thead>\n<tr>\n<th id=\"field_id-1\" scope=\"col\">A soft tissue biopsy of the lesion in the area of #7 was obtained. Given the historical, clinical, and radiographic findings of this case, which of the following diagnoses on the differential is most likely to reflect the patient\u2019s condition?<\/th>\n<th id=\"column_selector\" scope=\"col\"><\/th>\n<\/tr>\n<\/thead>\n<\/table>\n<ul>\n<li><label id=\"label_1_0\" for=\"choice_1_0\">A. Oral Squamous Cell Carcinoma\u00a0<strong>31%<\/strong><\/label><\/li>\n<li><label id=\"label_1_1\" for=\"choice_1_1\">B. Dentigerous \/ Periapical Cyst\u00a0<strong>37%\u00a0<\/strong><\/label><\/li>\n<li><label id=\"label_1_2\" for=\"choice_1_2\">C. Globulomaxillary Cyst\u00a0<strong>12%<\/strong><\/label><\/li>\n<li><label id=\"label_1_3\" for=\"choice_1_3\">D. Central Giant Cell Granuloma\u00a0<strong>20%<\/strong><\/label><\/li>\n<\/ul>\n<p>The <strong>Best Answer<\/strong> is B.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>This installment of Case Challenge features a 65-year-old Caucasian female presented for 6-month follow-up after non-surgical root canal treatment on #14 completed by an endodontic resident.<\/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-8961","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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