1 / 25

CASE OF THE MONTH

CASE OF THE MONTH. Submitted by: Dr. Cecil White Jr. HISTORY. 32 year-old female; Medical history within normal limits. OMFS performed LeFort I osteotomy in maxilla (w/BSSO in mandible). The mesial root of #6 was cut, and developed a persistent radiolucent area; no pain involved.

lok
Download Presentation

CASE OF THE MONTH

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. CASE OF THE MONTH Submitted by: Dr. Cecil White Jr.

  2. HISTORY • 32 year-old female; Medical history within normal limits. • OMFS performed LeFort I osteotomy in maxilla (w/BSSO in mandible). • The mesial root of #6 was cut, and developed a persistent radiolucent area; no pain involved. • #6 developed draining fistula w/no response to electric pulp tester. Subsequent pain upon mastication, 6 months later, prompted non-surgical endo to #6. • Referral to periodontist, 54 months following original orthognathic surgery.

  3. CLINICAL EXAM • 10 mm probing depth (PD) at mesial of #6, and 7 mm PD at distal of #7. • Miller’s Class I mobility of #6 and #7. • #6 displayed purulence and bleeding upon probing. • Radiographs displayed radiolucent area at mesial of #6, with partial loss of root structure in apical 1/3rd of tooth.

  4. TREATMENT PLAN • Phase I: • Scaling/root planing (SRP) of area performed. • Reevaluation at 8 weeks following SRP revealed persistent problem, with no improvement in probing depth/clinical attachment levels. • Phase II: • Open flap debridement to assess lesion/defect

  5. Pre-operative presentation- Facial surface

  6. Pre-operative presentation- Palatal surface

  7. Pre-operative radiograph

  8. INTRA-OPERATIVE FINDINGS • Combination 1- and 2-wall intrabony defect, extending from the mesial surface, to the distopalatal line angle of #6. • Vertical dimension of the defect ranged from 4-6 mm. • A 5 mm x 2 mm segment of gutta-percha was exposed, starting 4 mm apical to the CEJ.

  9. POTENTIAL TREATMENT OPTIONS • Application of Enamel Matrix Derivative (EMD) to defect and root surface of #6, closure. • Extract tooth #6, immediate implant to #6, bone graft/barrier, closure. • Glass ionomer cement to root surface defect, root surface conditioning with tetracycline (TCN), bone graft/TCN/barrier, closure. • Extract teeth #6 and #7, bone graft/barrier, closure; subsequent implant placement. • Extract #6, bone graft/barrier; subsequent placement of Fixed Bridge (#4 - #8).

  10. CHOSEN TREATMENT OPTION Glass ionomer cement to root surface defect, root surface conditioning with tetracycline (TCN), bone graft/TCN/barrier, closure.

  11. DFDBA graft/tetracycline combination placed into defect, following root surface conditioning with tetracycline and glass ionomer cement repair of root surface defect.

  12. Placement of expanded-polytetraethylene(e-PTFE) barrier

  13. Primary closure

  14. 6 weeks following barrier placement - Facial

  15. 6 weeks following barrier placement - Palatal

  16. Barrier removal at 6 weeks, with “regenerative” soft tissue present

  17. Re-entry of #6 area at 24 months following original open flap/root repair/bone graft procedure (i.e. “original” surgery)

  18. Restoration at 30 months following “original” surgery/6 months following “re-entry” procedure - Facial

  19. Restoration at 30 months following “original” surgery/6 months following “re-entry” procedure - Palatal

  20. Post-operative radiograph at 24 months post-operative

  21. PRE-SURGERY POST-SURGERY/RESTORATIVE

  22. PRE-SURGERY 24 MONTH POST-SURGERY

  23. SUMMARY • PROBLEM • Chronic periodontal lesion, with root surface defect, caused by errant section of root surface during orthognathic surgery procedure. • TREATMENT • Situation was treated with open flap debridement, repair of root surface defect with glass ionomer cement, root surface conditioning with tetracycline, combination DFDBA/tetracycline (4:1 ratio), and placement of e-PTFE barrier. • OUTCOME • 1 to 3 mm probing depths, no mobility, and no bleeding on probing to sites #6 and #7.

More Related