Endodontic Disease M

A 73-year-old woman has discomfort associated with #23 four months post Class V composite at #23-25 (Fig.1 C (*: Class V lesions)).  Bone loss seems to be more severe lingually, especially at the crest (Fig.2 L).  It appears that the apex of the tooth #24 is also in the large apical lesion (Fig.3).  Class V composite is apparently continuous with the pulp at #25,24,23 (Fig.5-7).  In contrast, Class V defect does not involve the pulp at #26 (Fig.4).  If necrosis is confirmed clinically for #23 24 and 25, RCT will be conducted.  Due to 7-day Amoxicillin taken for #3 implant, the patient feels that her tongue moves freely, as related to reduction in pain and swelling lingual to #23 (Fig.8 *).  Endo ice test shows necrosis of #23 to 25.  RCT is initiated at #23 (Fig.9) with buccal and lingual swelling.  Endo may have to be at #24 with apicoectomy with PRF.  The lingual swelling remains at #23, although there is no pain or purulent discharge 5 and 5.5 months post debridement (Fig.10,11).  RCT is finished (Fig.12).    Apicoectomy is pending with PRF.  Less aggressive curettage will be done at #24 to maintain apical blood supply.  Vitality tests have been done without conclusion.

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Xin Wei, DDS, PhD, MS 1st edition 11/11/2019, last revision 08/09/2020