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Primary molar with resorption


A 15 year old male patient was referred to our office complaining of pain radiating from the lower left area. He had been experiencing pain for approximately one month. The symptoms were exacerbated with hot or cold, or when chewing.

CLINICALLY:

Upon examination, it was discovered that this patient had a retained, deciduous molar. There was a significant amount of decay on the distal half of the tooth. The tooth demonstrated intense pain when tested with ice. There was also sensitivity upon percussion.

RADIOGRAPHICALLY:

Radiographs revealed a retained, deciduous tooth (tooth 75), showing extensive decay in the distal aspect of the crown. The decay extended into the pulp chamber. It was also apparent that partial resorption of the roots had taken place.

TREATMENT:

After consultation with the dentist, the patient and his parents, it was decided that we would try to retain this tooth by performing endodontic therapy, followed by restoration with a full crown. Due to the partial resorption of all roots, and the difficulty of attaining an apical stop in the root canals, the prognosis of treatment was guarded.

Adequate anesthesia was achieved in the lower left quadrant and a rubber dam was applied to the tooth. Access to the pulp chamber was created using a long, tapered, diamond bur. The shape of the access was identical to a permanent molar, only smaller in dimension. Four canals were located. Cleaning and shaping of this tooth was done in a conservative manner.

Due to the resorption of the root apex, it was difficult to achieve an adequate apical stop. Gates-Glidden drills could not be used due to the indenting of the furcal aspect of the roots: In deciduous teeth the roots indent on the furcal side, and are therefore very prone to iatrogenic problems such as stripping or perforating. We were able to achieve an apical stop with a size #40 file at the canal openings. Please note the distance from the canal openings to the root ends: This occurred due to root resorption.

The tooth was packed using vertical condensation with Kerr sealer and non-standardized gutta-percha cones.

pre-op x-ray post-op x-ray

DISCUSSION:

The long-term prognosis of this tooth may not be as ideal as the typical endodontic case. It is important that the patient (and in this case, the parents) were informed of both the risks and benefits of the treatment. This tooth, however, is important and was important in trying to retain: There was no permanent tooth present, so extraction of the 75 would have relegated this patient to a three-unit bridge (involving two virgin abutments), a removeable prosthesis or an implant. Given these considerations and the alternatives, everyone agreed this was the treatment of choice.




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