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A 60-year-old man with large DO amalgam at #30 develops pain and mild swelling apparently apical to #29. Both teeth (having fused PARL (periapical radiolucency) *) have mild percussion with the tooth #29 having higher mobility. CBCT shows apical defect (Fig.3 >). Three weeks earlier, the tooth #19 had much more severe infection with a similar apical defect (Fig.4 >). Combined with history of repeated infection associated with #30, the tooth is extracted. Because of severe infection it is difficult to obtain sound anesthesia. Socket preservation (Vanilla Graft: *) is performed instead of immediate implant (Fig.5). Osteotomy may cause extra pain intraoperatively.
Xin Wei, DDS, PhD, MS 1st edition 03/29/2018, last revision 03/31/2018