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A 43-year-old man requests #17 extraction (Fig.1,2); the tooth #18 has large periapical radiolucency at the distal root. After SRP and extraction, Osteogen plug is placed in #17 sockets (Fig.3 P), while Vanilla Cancellous/Cortical Mix (allograft) 18 distal (*). The wound is closed with 4-0 plain gut suture. Similar to his son, he has crowding with #10 cross bite, #11 labioversion and a possible supernumerary tooth (11'). Seven months postop, not only does the periradicular radiolucency decrease around the distal root of the tooth #18 (Fig.4 *), but also the mesial and distal sockets of the 3rd molar heal (M, D). The patient is concerned about the sensitivity of the tooth #18, which is stable with the healthy gingiva. The sensitivity disappears 1 year postop, but there is a ~ 10 mm pocket distal of #18. Endo ice test shows necrosis. Endodontic referral is recommended. If endodontic treatment is not practical, periodontal referral is next step with laser modality.
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2Xin Wei, DDS, PhD, MS 1st edition
10/02/2018, last revision
12/22/2019