Case 43 Root amputation still an option

Pre-operative x-ray #18

Apical lesion mesial root with 12mm pocket. Diagnosis: fractured root.

Post operative x-ray #18

Post amputation due to mesial root fracture.  Viable option to salvage bridge.

7 month post operative x-ray #18

With healing, bridge is firm.






Comments:
With the loss of a posterior abutment for a bridge, then the entire bridge is lost. Patient has two options either to try a root amputation or extraction with implants. Cost is always a factor, and in this case, it was a major factor.  Patient wanted to salvage the bridge as long as possible.  I think we have given this bridge more time.

Case 42 What happened?

Pre-operative x-ray #8

Patient is asymptomatic - digital x-ray shows a metal instrument or some kind of metal filling material bent at the apex of tooth #8. General dentist describes root canal treatment completed prior to 1991.

Photo showing object

Metal instrument in periapical lesion was not connected to the instrument or file in the canal. It is not a silver cone. The instrument or file had obviously corroded off at the apex of the canal system.

Photo of object (hemostat for scale)

Surgically treated, instrument in the canal could not be removed via apex.  If periapical healing does not occur, then retreatment may be an option.

Comments:

Retreatment is usually the most obvious option when root canal therapy fails.  However, a surgical approach is a valid option when retreatment may not be adequate.

Best advice is to have a periapical x-ray on a tooth prior to placement of a crown.