Page 56 - The Beauty and Sorrow in Endodontics-Chapter 3

DH: Extreme dental anxiety; past extractions due to failed endodontic treatment

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( 36) and unknown reasons ( 32).
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O I/O: 42, 41, 31 Gingival recession, PD WNL, STP (+?)
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41 Irregular craze lines around B/L cervical area
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Rad (Fig 40B, 40C): 31- 42 Moderate horizontal bone loss
31- 42 Apical radiolucency with internal opacities
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Vitality Tests:
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Endo Ice: 41 (++, non-lingering)
# 31, 42 (+, normal)
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Cavity Test: 31, 41, 42 (+, normal)
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A Dx: 31, 41, 42
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Pulpal: Normal ( 31, 32); Reversible pulpitis ( 41)
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Periapical: periapical cemento-osseous dysplasia (PCOD)
P Discussed proposed treatment plan with the patient. Informed consent obtained
to proceed.
1) Restore 31I, 41I, 42I (Fig 40D)
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2) Panoramic radiograph (Fig 40E)
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Apical radiolucency around 35, 45, 46
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3) Update periapical radiographs for 35, 45, 46 (Fig 40F, 40G, 40H)
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35, 45 Intact coronal tooth structure
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# 46 Large restoration with radiolucency under restoration and cervical
caries
4) CBCT (Fig 40J-X)
CBCT report received from oral radiologist two-weeks later confirmed

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PCOD on 37, 35, 31, 41, 42, 45, 46, and 47.
5) Discussion with patient
The carious lesion under the large restoration on tooth 46 should be
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treated as soon as possible to prevent any possibility of devitalizing the pulp.
Regular cleaning was recommended. Orthodontic treatment recommended
once her periodontal disease is treated and stabilized.
Note The patient was unable to identify significant discomfort to any particular
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