Clinical Cases in Endodontics (eBook)

Takashi Komabayashi (Autor)

eBook Download: EPUB

2017
John Wiley & Sons (Verlag)
9781119147060 (ISBN)

Infos

A problem-based text that presents a wide range of real cases in endodontics

Clinical Cases in Endodontics presents actual clinical cases, accompanied by academic commentary, that question and educate the reader about essential topics in endodontic therapy. It begins with sets of cases illustrating the most common diagnoses and the steps involved in preparing a treatment plan. Subsequent chapters continue in this style, presenting exemplary cases as the basis of discussing various treatment options, including nonsurgical root canal treatment, re-treatment, periapical surgery, internal and external resorption, emergencies and trauma, and treating incompletely developed apices.  The progression from common to increasingly challenging clinical cases enables readers to build their skills, aiding the ability to think critically and independently.

The Clinical Cases series is designed to recognize the centrality of clinical cases to the profession by providing actual cases with an academic backbone. Clinical Cases in Endodontics applies both theory and practice to real-life cases in a clinically relevant format. This unique approach supports the trend in case-based and problem-based learning, thoroughly covering the full range of endodontic treatment.

• Unique case-based format supports problem-based learning
• Promotes independent learning through self-assessment and critical thinking
• Covers all essential topics within endodontics
• Presents numerous illustrations and photographs throughout to depict the concepts described

Clinical Cases in Endodontics is an ideal resource for students mastering endodontic treatment, residents preparing for board examinations, and clinicians wanting to learn the most recent evidence-based treatment protocols.

The Editor

Takashi Komabayashi, DDS, MDS, PhD, is a Diplomate of the American Board of Endodontics and Clinical Professor at the University of New England College of Dental Medicine in Portland, Maine, USA.

Inhalt

Clinical Cases in Endodontics v

Contributors ix

Acknowledgements xi

Chapter 1 Introduction 1
Takashi Komabayashi

Chapter 2 Diagnostic Case I 5

Tooth Fracture: Unrestorable
Suanhow Howard Foo

Chapter 3 Diagnostic Case II 11

Exploratory Surgery: Repairing Incomplete Fracture
Keivan Zoufan, Takashi Komabayashi, Qiang Zhu

Chapter 4 Emergency Case I 20

Interprofessional Collaboration between Medical and Dental
Andrew Xu

Chapter 5 Emergency Case II 27

Pulpal Debridement, Incision and Drainage (Intra-oral)

Victoria E. Tountas

Chapter 6 Emergency Case III 37

Pulpal Debridement, Incision and Drainage (Extra-oral)
Amr Radwan, Katia Mattos

Chapter 7 Non-surgical Root Canal Treatment Case I 45

Maxillary Anterior, Denise Foran

Chapter 8 Non-surgical Root Canal Treatment Case II 53

Mandibular Anterior
Jessica Russo Revand, John M. Russo

Chapter 9 Non-surgical Root Canal Treatment

Case III 63

Maxillary Anterior/Difficult case (Calcified Coronal ½ Canal System)
Andrew L. Shur

Chapter 10 Non-surgical Root Canal Treatment Case IV 72

Maxillary Premolar, Daniel Chavarría-Bolaños, David Masuoka-Ito, Amaury J. Pozos-Guillén

Chapter 11 Non-surgical Root Canal Treatment Case V 79

Mandibular Premolar
Takashi Okiji

Chapter 12 Non-surgical Root Canal Treatment

Case VI 91

Mandibular Premolar / Difficult Anatomy (three canals)
Savita Singh, Gayatri Vohra

Chapter 13 Non-surgical Root Canal Treatment Case VII 98

Maxillary Molar/Four Canals (MB1, MB2, DB, P)
Khaled Seifelnasr

Chapter 14 Non-surgical Root Canal Treatment Case VIII 105

Mandibular Molar
Ahmed O Jamleh, Nada Ibrahim

Chapter 15 Non-surgical Root Canal Treatment Case IX 113

Maxillary Molar /Difficult Anatomy (Dilacerated Molar Case Management)
Priya S. Chand, Jeffrey Albert

Chapter 16 Non-Surgical Re-treatment Case I 122

Maxillary Anterior
Kana Chisaka-Miyara

Chapter 17 Non-surgical Re-treatment Case II 129

Maxillary Premolar
Yoshio Yahata

Chapter 18 Non-surgical Re-treatment Case III 136

Mandibular Molar
Bruce Y. Cha

Chapter 19 Periapical Surgery Case I 147

Maxillary Premolar
Pejman Parsa

Chapter 20 Periapical Surgery Case II 154

Apical Infection Spreading to Adjacent Teeth
Takashi Komabayashi, Jin Jiang, Qiang Zhu

Chapter 21 Periapical Surgery Case III 164

Maxillary Molar
Parisa Zakizadeh

Chapter 22 Perio-Endo Interrelationships 172
Abdullah Alqaied, Maobin Yang

Chapter 23 Traumatic Injuries 179

Avulsed and Root-Fractured Maxillary Central Incisor
Bill Kahler, Louis M. Lin

Chapter 24 Incompletely Developed Apices 188
Nathaniel T. Nicholson

Chapter 25 External/Internal Resorption 200
Keivan Zoufan, Takashi Komabayashi, Qiang Zhu

Index

Textauszug

Chapter 2
Diagnostic Case I:
Tooth Fracture: Unrestorable

Suanhow Howard Foo

Learning Objectives

• To apply knowledge of dental anatomy to clinical procedures involving a cracked tooth.
• To be able to interpret radiographs used in endodontic diagnosis.
• To formulate a correct endodontic diagnosis and treatment plan based on a variety of clinical testing procedures, taking into account factors such as loss of tooth structure, bruxism, age, and gender.
• To understand the prognosis and incidence rates of the various types of root fractures.

Chief Complaint

“I had excruciating pain last night, now I can't touch my tooth.”

Medical History

The patient (Pt) was a 58-year-old male Caucasian. He presented with nothing significant in medical history and no allergies to any medications or to latex. Vital signs were: Blood pressure (BP) 132/87 mmHg, pulse 82 beats per minute (BPM), respiratory rate (RR) 17 breaths per minute.

The Pt was American Society of Anesthesiologists Physical Status Scale (ASA) Class II.

Dental History

Pt had on-and-off pain on the lower right quadrant for a few weeks and was referred for an evaluation of tooth #31. The tooth had a mesial (M) to distal (D) crack. The tooth was painful to touch and the Pt could not eat or bite on that tooth. Pt reported a history of bruxism.

Clinical Evaluation (Diagnostic Procedures)

Examinations

Extra-oral Examination (EOE)

No asymmetry, no lymphadenopathy, no deviation of jaw when opening, no swelling, and temporomandibular joint (TMJ) was within normal limits (WNL).

Intra-oral examination (IOE)

Oral cancer screening performed with all tissues WNL. Tooth #31 had a M to D crack. Periodontal exam showed probing depths from M to D of Facial (4 mm, 3 mm and 8 mm) and M to D of Lingual (4 mm, 4 mm and 8 mm). Tooth #31 had type 1 mobility. Tooth #30 had probing depths from M to D of Facial (4 mm, 3 mm and 4 mm) and M to D of Lingual (4 mm, 4 mm and 4 mm). Tooth #31 had pain with bite test and pain when occluding. Methylene blue dye and fiber optics showed fracture was through and through and extended below the cementoenamel junction (CEJ).

Diagnostic Tests

Tooth

#29

#30

#31

Percussion

–

–

+

Palpation

–

–

–

Cold

Normal

Normal

–

Mobility

None

None

Class 1

Bite

–

–

+

+: Response to percussion, or bite stick test;

– : No response to percussion, palpation, cold, or on bite stick test

Radiographic Findings

Tooth #31 had a radiolucency that extended from the D cervical area to the apex of the D root. A crack could be seen on the D portion of tooth #31 with the D restorative material fractured. (See Figures 2.1 and 2.2.)

Figure 2.1 The initial radiograph of tooth #31. Notice the shallow restoration and the periapical rarefaction at the root apices.

Figure 2.2 The extent of rarefaction in the distal root of tooth #31. Note how the radiolucency moves up to the alveolar crest.

Pretreatment Diagnosis

Pulpal

Pulp Necrosis, tooth #31

Apical

Symptomatic Apical Periodontitis, tooth #31

Treatment Plan

Recommended

Emergency:Extraction, tooth #31

Definitive:Extraction, tooth #31

Alternative

No treatment

Restorative

Implant or Fixed Prosthetics

Prognosis

Favorable

Questionable

Unfavorable

X

Clinical Procedures: Treatment Record

First visit (Day 1): Exam: Pt was referred for an evaluation of tooth #31. Medical history (Hx) and vital signs were taken. Three periapical (PA) radiographs were prescribed in order to evaluate the PA area for possible infection and to determine the extent of the crack. The radiographs showed PA rarefactions (Figures 2.1 and 2.2) at root tips and bone loss in D root area. Clinical tests and exams were performed. Tooth #31 had an M to D crack that was verified with methylene blue (Figure 2.3) and a fiber optic light (Figures 2.4 and 2.5). The tooth could be separated in a buccal–lingual (B–L) manner with light touch. The defect could be seen extending to the pulpal floor. Pt was informed that the prognosis of the tooth was unfavorable and that extraction was needed to alleviate his pain and for healing to occur. The Pt accepted treatment (Tx) of extraction of Tooth #31. The extracted tooth was photographed and confirmed the initial diagnosis of a root fracture and split tooth (Figure 2.6).

Figure 2.3 Mesial to distal crack of tooth #31, stained with methylene blue to better visualize the extent of the crack.

Figure 2.4 Fiber optic light illumination of tooth #31 shows that the crack goes below the CEJ. The light does not pass through from lingual to buccal.

Figure 2.5 Fiber optic light was used on the buccal surface to confirm the crack.

Figure 2.6 Diagnosis of a split tooth is confirmed after the extraction of tooth #31.

Post-Treatment Evaluation

Second visit (1-week follow-up): Pt returned for a post-operative (PO) follow-up. The area around the extraction site of tooth #31 was neither inflamed nor swollen. Gingival tissue had already begun to fill in the socket. The Pt was able to eat and brush his teeth in the lower right quadrant.

Self Study Questions

1. A. How is a fractured tooth diagnosed?

2. B. What are the types of cracks one may see in a suspected tooth fracture?

3. C. What is the prognosis for a cracked tooth?

4. D. How is a cracked tooth treated?

5. E. What is the incidence rate of fractures?

Answers to Self-Study Questions

1. A.

   There are multiple ways to determine whether or not a tooth is fractured. It is important to start with a good dental history of the tooth. A clinical exam should include a bite stick, ice for vitality testing, and a periodontal probing to check for deep narrow pockets. A radiographic exam is important to check for periapical rarefactions or possibly to reveal a fracture itself if it is large enough. Finally, a stain (methylene blue), or trans-illumination may be used to visualize the fracture. Sometimes the tooth may be mobile or a sinus tract may have developed due to fracture necrosis. If a tooth is non-vital with minimal or no restorations, suspect a crack or fracture (Berman & Kuttler 2010). The older the tooth, the more susceptible it is to fracture (Berman & Kuttler 2010). Cracked teeth are more commonly found in lower molars, followed by maxillary premolars (Cameron 1976). Another study found that lower 2nd molars were more likely to have cracks after root canal treatment (Kang, Kim & Kim 2016).

1. B.

   According to the American Association of Endodontics (Rivera & Walton 2008), there are five categories of crack:

   • Craze lines: Only involving the enamel;
   • Split tooth: Complete fracture through the tooth, usually centered mesial to distal;
   • Fractured cusp: Usually non-centered and affecting one cusp;
   • Cracked tooth: An incomplete fracture that extends from the crown to the subgingival area of the tooth; and
   • Vertical Root Fracture (VRF): This may be symptomatic or non- symptomatic. The majority of the VRFs are associated with root-filled teeth. It may be a complete or an incomplete fracture.

1. C.

   The prognosis for a cracked tooth is always going to be questionable (Rivera & Walton 2008). The prognosis is always better if the crack does not extend to the pulp chamber floor (Turp & Gobetti 1996; Sim et al. 2016). Vital is better than necrotic (Turp & Gobetti 1996). The quality of the restoration and whether a full coverage crown may cover the crack and other defects are considerations (Rivera & Walton 2008), as is whether an abscess or radiographic rarefaction is present prior to treatment. These two factors would lower the prognosis of the tooth in question (Berman & Kuttler 2010). One study found that cracked teeth had a two-year survival rate of 85.5% (Tan et al. 2006). Another study found that after five years, the survival rate of root-filled cracked teeth was 92%, with the odds of extraction increasing if the cracks were in the root (Sim et al. 2016). Finally, a recent study from Korea showed a 90%, two-year survival rate for a cracked tooth, probing depths greater than 6 mm being a significant factor in the prognosis (Kang et al. 2016).

1. D.

   After removal of all caries or previous restorations,...

Produkt-Details

• Erscheint lt. Verlag: 27.12.2017
• Reihe/Serie: Clinical Cases (Dentistry)
• Reihe/Serie: Clinical Cases (Dentistry)
• Reihe/Serie: Clinical Cases (Dentistry)
• Sprache: englisch
• Themenwelt: Medizin / Pharmazie ► Allgemeines / Lexika
• Themenwelt: Medizin / Pharmazie ► Gesundheitsfachberufe
• Themenwelt: Medizin / Pharmazie ► Zahnmedizin
• Schlagworte: anatomy • Biomedical Science • Clinical Dentistry • DDS degrees • Dental education • Dental Hygiene • dental research • Dental School • Dental Surgery • dental therapy • dentistry • dentists • Einführung i. d. Zahnmedizin • endodontic • Endodontics • endodontic therapy • Endodontie • Endodontik • external resorption • Histology • internal resorption • Introductions to Dentistry • introductory dentistry • Maxillofacial Pathology • Medical Science • nonsurgical root canal treatment • Oral Biology • oral bioscience • oral hygiene • oral microbiology • Oral Science • Oral surgery • orthodontia • Periapical Surgery • Physiology • Pulp Regeneration • root canal • Zahnmedizin
• ISBN-13: 9781119147060 / 9781119147060