Page 54 - The Beauty and Sorrow in Endodontics-Chapter 2

moment and can be re-infected.

10-months – The patient returned with the chief complaint of a new abscess
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apical to tooth 11. Periapical radiographs showed enlarged lesion
compared to the pre-op radiograph (Fig 29L, 29M). Due to the

inability to schedule a time that works for the patient, a course of
antibiotic (Clindamycin 300mg TID for 14 days) was prescribed to

prevent the infection from spreading and the patient was asked to

return for 11 apical surgery when he becomes available.
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2.5-years – The patient returned for apical surgery of 11. 2
Intrigued by the etiology of the infection, the author filtered through all
existing images pertaining to the case. Deep caries and coronal leakages were

ruled out first due to the moderate size of the restoration and lack of leakage
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under microscopic examination (Fig 29N). Secondly, tooth 11 was
periodontally healthy; no calculus, recession or deep probing depths were noted,

therefore ruling out periodontal etiology as well (Fig 29O). Lastly, incisal
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attrition was noted on both 11 and 21 prior to Invisalign treatment and the
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post-Invisalign radiograph showed resorbed apex of tooth 11with apical
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radiolucency (Fig 29P, 29Q). Therefore, it is highly suspected that patient had
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sustained traumatic injury on tooth 11 either from parafunctional occlusion or
bruxism.
1
Note For other treatments for this patient, see “Cases 86, 94”
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2 For the apical surgery of 11, see “Case 86”

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