Case Presentations PDF

CASE PRESENTATIONS Leigh R. Busch, D.D.S. Director, Predoctoral Endodontics New York University College of Dentistry  Techniques for treating necrotic open apex cases Six year old fell off a bike hit face no fracture of teeth, Slight Mobility 6 Months later child complained of pain in his to...

CASE PRESENTATIONS Leigh R. Busch, D.D.S. Director, Predoctoral Endodontics New York University College of Dentistry  Techniques for treating necrotic open apex cases Six year old fell off a bike hit face no fracture of teeth, Slight Mobility 6 Months later child complained of pain in his tooth 2 years after treatment started, area healed bridge formed, ready for obturation 12 Yr Old Asian Boy Note Occlusal Tubercle— Dens Evaginatus Fitted Point Short MTA Apical Seal Tubercle on Upper Lateral Note Canal Size Open Apex Non Vital Tooth Intra-visit canal dressed with calcium hydroxide for three weeks 11/15/2013 Revascularization W/ MTA Acute Apical Abscess I&D What is going on in the canal system of tooth #28  on the next slide? Observe the first premolar  An Obvious Canal in the Coronal/3  Canal Disappears  Frequently Mistaken for a Calcified Canal Canals are B&L Not M&D Periapical Diagnosis? Treatment? Periapical Diagnosis? Treatment? Healthy 12 Yr Old Swelling, Mobile Spontan eous Pain Non  4 Months Post- Op  Complete Bone Fill  No Perio Treatment Bleeding while doing access Pt to me After GDDS Started RCTs Cuspid Working Length Leaving Next Week For 3 Months Air Embolus Use of Air Syringe NaOCl Accident Swelling in Fold, Distal Abutment of Long Span Bridge Note Apico W/ RGA on PM Now What? 2nd Molar No Apparent Canals. How to Treat?  82 Yr Old     Male Bld Pr Med Aleve for Arthritis Pain to Cold & Chewing Diagnosis? Completed Root Canal – Canals Filled to Apex I don’t want to lose another tooth! Options? 56 Yr Old Female, on Lipitor & Fosamax  Bone Loss Along Mesial of Root and Periradicular Region  Asymptomatic  Calculus Present  Tooth is Elevated in Socket  Perio, Endo or Both?  Diagnosis? How Would You Treat This PT? PAPs, OK RCTs, Posts,Crowns? Very Large PAP What’s Going on Here? How Do You Leave This? Is It Necessary to Control an Infection with Antibiotics Prior to RCT? No!! Attempt to Establish Drainage & Remove the Cause of Infection  So you can’t think of anything worse than root canal Irreversible Pulpitis  VITAL TOOTH  Classic Symptom: Lingering Pain to Cold  May Or May Not Be Sensitive To Percussion  Some Cases Pain With Heat Relieved By Cold  RCT Required Reversible Pulpitis  VITAL TOOTH  Thermal Sensitivity—Not lingering  Frequently Post Treatment  No Treatment Indicated Chronic Apical Periodontitis  Non Vital—No Response To Thermal Stimuli Or EPT  Asymptomatic  Periradicular Radiolucency Present  No Pain To Percussion  RCT Indicated Acute Apical Periodontitis  Tender To Percussion  May Be Vital Or Non Vital  May Or May Not Require RCT  Many Reasons For Chronic Suppurative Periodontitis  AKA Chronic Apical Abscess  Non Vital—Necrotic Pulp  Draining Sinus Tract or Fistula  Usually Asymptomatic Due To Drainage  Requires RCT Acute Apical Abscess  Non Vital—Necrotic Pulp  Spontaneous Pain  May Or May Not Be Swelling  Pain To Percussion & Palpation  May Or May Not Be PAP