Page 28 - The Beauty and Sorrow in Endodontics (Chapter 4 - Part 2)

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were observed draining out from 28 extraction site. A few possible scenarios
were discussed with the patient and her husband:
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a) During extraction of 28, excess pressure placed on 27 during elevation
resulted in 27 root fracture;
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b) After the extraction of 28, tooth 27 has sustained most of the forces
from her occlusal parafunction, which exacerbated the cracks; or
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c) The extraction socket of 28 did not heal properly.
Open flap surgery was recommended for the following reasons:
a) It allows for direct visualization for the presence of root fracture, and

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b) If no fracture, then root planning of 27 as well as removal of the
granulation tissue within 28 extraction socket can be performed at the
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same appointment to aid in pocket reduction; or
c) If root fracture is present, then the tooth can be extracted and bone graft

placed at both 27 and 28 site in preparation for future implant placement.

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4) 27 Extraction (6 months later; 3 years since 27 RCT)
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The patient’s husband reported that 27 crown had fractured off and clearly
discernible cracks on both mesial and distal margins were observed (Fig 47P).

They had extracted the tooth and completed bone graft at both 27 and 28

extraction sites (Fig 47Q, 47R). On the extracted tooth, the crack on the distal
surface had extended down the palatal root (Fig 47S), and the crack on the

mesial surface had extended down the buccal surface of the palatal root all the
way to the apex (Fig 47T).

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