Case 15 Surgically treating primary teeth

Pre-operative x-ray primary tooth K

immediate post-operative x-ray

Patient presented with a symptomatic periapical lesion.

7 month post-operative x-ray

Comments:
Patient had a relatively new crown and we discussed possible retreatment.  However, it seemed that a surgical approach would probably be the most appropriate with the best results.  Patient understood if a fracture was present, the tooth would be removed.  It is obvious from the x-ray that crown-root ratio is very important and has to be taken into consideration when surgically treating these kind of teeth. Every attempt was made to keep the crown-root ratio the same while removing the apical lesion and placing retrofills.

Case 14 - Reimplantation as option to orthograde/surgical treatment tooth #18

Post-operative x-ray #18

Pre-operative x-ray #18

 

 

 

 

 

 

 

Five year follow up x-ray #18

Comment: Patient was very symptomatic and the root canal had been done some years previous. The anatomy was such that a surgical approach was not optimal due to a very broad buccal plate. The patient had TMJ problems which made an orthograde treatment difficult at best with a poor prognosis. My first thought was the possibility of a fracture, though there were no periodontal problems.  The time involved in removing a tooth, placing retrofills and re-implantation is about 5 minutes.  At the five year follow up the patient was asymptomatic and the tooth was firm with no periodontal problems.  The radiolucency at the apex was completely healed. The PDL space seems to have regenerated.

Case 13 Exposing the pulp chamber

Pre-operative x-ray #19

When patient first presented for treatment. Patient was very symptomatic and told me dentist could not find all the canals.

Photo before treatment

Temporary that was in place removed, pulp chamber not touched

Please note: "material" fills mesial half of pulp chamber????

Photo after treatment

Pulp chamber fully exposed all canals easily identified.






Comment:
All canals need to be readily seen in order to be cleaned properly. The floor of the access opening must be large enough to demonstrate all three or four canals. Please note: The pulp floor is a different color than the walls of the access opening. Follow the color and you will find the canals.

Case 12 Tooth with no visible (negotiable) canal system

Pre-op tooth #12

Tooth was symptomatic. Radiographic evidence of no canal system. In this case, surgical approach was necessary as canals could not be negotiated (I tried).

Immediate post-op tooth #12

Surgical approach with 2 retrofills.
Note: the density at the end of the root is not a root tip.

18 month check x-ray tooth #12

Tooth was asymptomatic.





Comment: When radiographic evidence shows no evidence of a negotiable canal system, you must look. Orthograde treatment almost is always better than a surgical approach without benefit of obturated canals.  However, in some cases surgery is necessary and retrofills must be placed. As the canal systems have never been cleaned, close follow-up is always necessary.  If there is any evidence of a radiographic lesion developing or patient experiencing symptoms, the surgery must be redone or the tooth extracted.  Don't forget, a detailed explanation to the patient is extremely important.