12 year old girl presented with broken incisal edge having history of fall 3 years before.clinical examination reveals complicated crown fracture. vitility tests reveals necrotic pulpal status
Another similar case picture
Treatment options in Complicated crown root fracture (Case report article in PDF) Archives of Orofacial Sciences (2009), 4(1): 25-28
Management of Horizontal and Multiple Crown-Root Fractures( case report in PDF) World journal of dentistry 2011
Guideline on Management of Acute Dental Trauma The American Academy of Pediatric Dentistry (AAPD)
Dental trauma guidelines 2011 International Association of Dental Traumatology (IADT)
Vertical root fracture Wikipedia
A lecture in PDF by Bill Blood of Case Western Reserve University, Cleveland, Ohio
Scanned chapter from some unknown sports medicine book with comprehensive text and pictures.
Article from ‘A Summary Journal of Advances in Dentistry and Oral Health Care’
Article published in Int. J. Odontostomat.(2008)
From Google images
A case report published in RSBO by Diego Henrique et al.
A case report published in Journal of oral science 2012 Tamotsu et al.
Question no 1: the objective of incision and drainage are
- To evacuate exudates and purulence from a soft tissue swelling
- Incision for drainage increases discomfort
- Drainage through the soft tissue accomplished most effectively when swelling is firm and non- fluctuant
- Incision for drainage is always made horizontally into the swelling
- Incision of drainage speeds up healing process
Question 2: Peri apical surgery is indicated
- When there is persistent peri apical infection that cannot be resolved with non- surgical root canal re- treatment
- When there is true cyst
- Severe periodontal disease
- Irretrievable posts and root fillings and there removal would result in further damage to the root structure
- Unidentified cause of conventional root canal failure
Question 3: root end resection
- It removes the untreated apical portion of root
- It provides angled surface to prepare a root and cavity preparation
- It should be perpendicular to long axis of tooth
- It expose additional canals, apical deltas, or fractures
- It should be around 5 mm because most of additional canals are present in apical 5mm
Question 4: indication for root amputation or hemisection
- Preservation of strategically important roots and its accompanying crown
- Root fusion or proximity
- Untreatable roots with broken instruments, perforations, caries, resorption and calcified canals
- Severe periodontal disease
- Inability to complete root canal treatment on either half.
Question no 5: root end cavity preparation
- Are now made with ultrasonic tips
- Preparation should be class one type in the apical portion of canal
- It should have a minimum depth of 3mm
- It should have a minimum depth of 5 mm
- The walls of the preparation will be slightly oblique with long axis of the root
Question 6: Thirty year old patients presented to you with chief complain of chewing. Radiographic examination reveals furcation caries and bone loss that has compromised the distal root. Which surgical procedure will be indicated for management?
- Apical surgery
- After root canal treatment, crown will be divided through the furcation
Radiograph showing radio-opacity associated with distal root of mandibular 1st molar. This bone production is because of reaction to carious infection. Tooth is irreversibly inflamed and treated with endodontic treatment.
46 pages notes by UMKC School of Dentistry
Presentation with pictures
Notes by LSUHSC School of Dentistry
Video on YouTube by Dr. In.Saini
It’s one of the painful dental emergency results from extension of bacterial infection from dead pulp into the periapical tissues.
Acute Apical Abscess are of Two types
- Increase exposure to fluoride during tooth formation will lead to dental fluorosis.
- Normal optimum level of water fluoride is upto 1ppm
- Increasesd level of fluoride more then 1ppm will cause fluorosis
- Clinically it appears as white opaque areas to brown discoloration and pitting of enamal
- In severe cases hypomineralised enamel becomes very fragile and undergo surface damage
- Management of dental fluorosis varies according to severity
- In Mild cases micro and macro-abrasions and bleaching are treatment options
- In moderate cases composite restoration and veneers are treatment options
- In severe cases full crowns
A female patient aged 21 came to conseravtive department with the chief complian of discolored upper central incisor.discoloration is present since her childhood. Clinically the discolration is of mild grade according to dean’s index
Mild grade fluorosis
Case no 2
23 year ol female with the chief complain of discoloration and tooth surface loss in upper anterior region.On examination mild to moderate grade fluorosis according to dean’s index
Mild to moderate grade fluorosis
Management with composite restoration
Broken instrument is one of the procedural accidents that occurs during cleaning and shaping of root canal system.
Causes of broken instrument in root canal:
Improper use of instrument
Same instrument used for many times
Excessive force applied to file during cleaning and shaping
Lubrication of instrument with irrigating solution such as sodium hypochlorite or with lubricating agent EDTA (ethyl diamine tetra acetic acid)
Instrument should be examined before use, if there is and untwisting in file which will be visible as shiny spot then it should be discarded
Small no. of files must be discarded after single use.
NiTi files do not show any sign of untwisting so they must be discarded before untwisting is seen
There are three methods of management
Make an attempt to remove it
Attempt to bypass it
Fill and obdurate it.
This is the radiograph of 25 year old male presented with pain in lower right and left 1st incisors. The teeth had been endodontically treated 2 years before. Periapical radiograph showed inadequate filled canals and periapical radiolucency associated with lower right and left 1st and 2nd incisors and broken instrument in left lower 1st incisor.
Gingivectomy procedure pictures
Preoperative picture of patient showing cervical caries extending subgingivally
Infiltration anesthesia was given for gingivectomy
Incision for removal of soft tissues
Incision starting from mesial marginal gingiva to distal marginal gingiva
After removal of soft tissue gingiva. subgingiva Caries are visible
Removal of caries
After removal of all soft caries leaving only hard and arrested caries
Application of retraction cord to stop bleeding
Application of 37% phosphoric acid
After washing and drying. Note white frosted appearance
Application of bonding agent
Light curing of bond
Application of composite resin- A2 shade
After Polymerization of composite resin
Postoperative view following composite placement
Dental Fistula/ Cutaneous Fistula of Dental Origin/ Suppurative Apical Periodontitis/ Apical Periodontitis With Fistula.
Dental fistula is a communication between the oral cavity and cutaneous surface of face
It is a squeal of infection from dental pulp that spread beyond the apex
Generally it is a painless condition because when drainage occurs, pressure relieves and symptoms disappear.
Chronic inflammation involves apical portion of tooth’s root.
Drainage mostly occur within oral cavity on facial or buccal side of alveolar ridge
Rarely occurs on cutaneous surface of face
Intraoral sinus tracts are common but extra oral fistula is not common.
Treatment involves complete debridement and obturation of root canal or Extraction.
This is the case of 10 year old patient with the chief complain of draining pustule from one month. Clinical examination reveals extraorally cutaneous draining fistula, intraorally grossly carious left mandibular 1st molar. Vitality test was negative. Radiographic findings are radiolucency associated with distal root of 1st molar and open apices. gutta percha point was used to trace the fistulas tract and was confirmed from radiograph it was associated with mandibular 1st molar. Diagnosis was chronic apical abscess or suppurative periodontitis with fistula.
Diagnosis and treatment of odontogenic cutaneous sinus tracts of endodontic origin: A case report International Journal of Dental Research, 2 (1) (2014) 8-10
23 year old female was referred for dental treatment with the chief complain of pain in mandibular right 1st molar. Clinically the tooth was grossly carious. Periapical radiograph revealed coronal caries involving pulp and periapical radiolucency associated with mesial root of mandibular 1st molar. From the history of pain and examination it was confirmed that patient had irreversible pulpitis so root canal treatment was performed.during access cavity preparation iatrogenic furcation area gets perforated and tooth was difficult to treat and extraction was indicated.mandibular 3rd molar of same site was clinically and radiographically sound and decision was made to transplant 3rd molar in place of extracted 1st molar.
Periapical radiograph showing extensive coronal caries and periapical radiolucency associated with mesial root
Root canal treatment was performed
Radiograph of donor tooth (3rd molar)
Arrow indicating the tooth to be extracted
Elevation of gingival tissues with periosteal elevator
Sectioning of tooth into two for easy removal, to prevent trauma and to preserve buccal and lingual alveolar bone
Tooth was sectioned with fissure bur
Tooth sectioned into two
Radiograph showing sectioned tooth
Removal of granulation tissue from the recipients site
Extraction of donor tooth
Root end cavity preparation of donor tooth
Root end filled with amalgam
Donor tooth transplanted in recipient’s site
transplanted was tooth stabilized with suture 3/0 silk that passed over the crown
Radiograph showing transplanted tooth
The tooth was stabilized with suture for 2 weeks
Root canal treatment of donor tooth was performed after 1 week
Radiograph of donor tooth taken at time of taranplantation
Radiograph of donor tooth after two month. Note the healing of periodontium around the tooth