Page 48 - The Beauty and Sorrow in Endodontics (Chapter 4 - Part 2)

denture inserted.

O E/O: Bilateral tenderness to palpation of TMJ and masticatory muscles

I/O: Gingival sensitivity around 47 implant
#
# 36 STP (+), APT (+)

#
37 STP (-), APT (-)
# 46 STP (slight +), APT (slight +), DL/DB 4-5mm

Rad (Fig 50A, 50B, 50C) :
2
Osseous: NSF
#
Inflammatory: 36M, 46 widened PDL (but intact lamina dura)
#
#
Bone loss: 46D vertical bone loss
Restoration:

Maxillary all-on-8 Implant-supported fixed denture
Bridge: 46-45-44-43; 42-41-31-32; 33-34-35 (all root canal treated)

#
46 Crown (adequate marginal seal)
#
47 Implant
#
RCT: 46 (inadequate obturation)
Supereruption: 37
#
A Dx: Possible TMD due to stress
P Discussed with the patient and her husband that her symptoms are likely related to

TMD instead of diseased teeth. She will forward over the radiographs from her
previous office before a definitive plan is set.

1) Discussion of previous radiographs (1-week since consultation)

The patient returned to the clinic reporting improvements to her symptoms

now that she has been assured no more extractions are required.

Radiograph (Fig 50D) taken 10days before the initial consultation (at the second

implant specialist’s office) showed no significant difference from the initial
consultation.

Radiographs taken a year ago (Fig 50E, 50F) showed no significant difference

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