Page 46 - The Beauty and Sorrow in Endodontics-Chapter 3

1) Poor oral hygiene

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2) 46 grade 2 mobility
3) Generalized periodontitis
4) Plan to extract 11, 46, 48 and a supernumerary tooth beside 21
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5) Sequential periodontal treatment with bone graft
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6) Implant placement for 11, 46, 48
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DH: Antibiotic therapy for 1 week for 46
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O I/O: Gingival erythema around 46
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# 46DO Amalgam restoration; no cracks; STP (+); APT (+); 46L PD 7-8mm
with bleeding; M1
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Rad(Fig 39A, 39B, 39C, 39D, 39E) :
Osseous: NSF
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Inflammatory: 11 periapical radiolucency, 46 furcal and periapical
radiolucency

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Bone loss: Generalized moderate horizontal bone loss; 46 furcation
involvement

Caries: 48O
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Others: Calculus; 48 mesially impacted; supernumerary tooth between 11/21
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Sinogram with GP cone points to 46 furcation
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Rad (Fig 39F, 39G) :
# 46 has separate DB and DL roots

A Dx: 46
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Pulpal: Necrotic

Periapical: Chronic apical abscess

Etiology: Pre-op: Combined endo-perio?
Post-op: Endo only

P Discussed proposed treatment plan with the patient. Informed consent obtained to

proceed.
1) Scaling with hygienist

Before scaling and 2-weeks post-scaling photos taken to show patient (Fig
39H, 39I)

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