Case Studies

Diagnostic Puzzles

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Five Year Follow-Up of Heroic Anterior Tooth Save:UPDATE

UPDATE: Recurrent Endodontic Disease After Initial Healing, 4 years later

Patient: 52 year-old (2014) male in excellent health

Chief Complaint: Patient reported a bump on the gums above his front upper tooth

Dental History: Patient reported a history of prior orthodontics as a child and previous endodontic treatment performed on the maxillary left and right central incisors in 1970 (teeth #’s 8 and 9). Surgical endodontic treatment had been performed years ago after a recurrent infection associated with the maxillary left central incisor (tooth #9)

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UPDATE 1 year Recall: Mandibular First Molar Presumed Split, but not.

Not all teeth that look split are split; expect the unexpected!

Patient: 49-year-old male with controlled hypertension and hypercholesterolemia

Chief Complaint: Swelling on the cheek-side of his right lower molar

Dental History: The patient reported having had a bonded resin filling material having been placed in his mandibular right first molar approximately 6-12 months prior to the time of examination. His dentist had reported a crown fracture and on a recent cleaning visit buccal swelling was noted with a 12 mm sulcular defect communicating with the buccal furcation. The dentist was certain the tooth was split and referred the patient to the author because the patient insisted upon wanting to see if the tooth could be saved.

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Detecting a Challenging Root Anomaly: Conclusion to Puzzle


Patient: 79 year-old male with glaucoma

Chief Complaint: Biting, Chewing Sensitivity on the lower back right jaw area

Dental History: The patient presented with no recent restorations and biting sensitivity localized to the mandibular right first molar (tooth #30) which had a full gold crown placed many years earlier

Significant Findings (tooth #30): The tooth measured a positive response to cold thermal stimulation, severe chewing sensitivity, and moderate percussion sensitivity. The periodontal and all other clinical findings were within normal limits. The radiograph demonstrated a radiopacity at the mesial and distal distal areas of the crown approximating the mesial and distal pulp horns.

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