The root filling of tooth #24 was 2 mm short of apex. The lucency measured approximately 20 × 12 mm in diameter and associated with broken lamina dura at the apices of teeth #23, #24, and #25. Diagnostic Tests ToothĮPT: Electric pulp test +: Normal response to cold or EPT –: No response to percussion or palpation N/A: Not applicable Radiographic FindingsĪ large ill-defined PARL was seen at the apices of teeth #23, #24, and #25 ( Figure 20.3). Periodontal probing depths around teeth #23, #24, and #25 were 2–3 mm with no mobility. The access cavity of teeth #23 and #25 was restored with Fuji IX GP ® (GC America Inc., Alsip, IL, USA) glass ionomer cement. Teeth #23, #24, and #25 exhibited mild tenderness to palpation in the labial vestibule. Perioral and intra-oral soft tissues appeared normal. The clinical examination revealed submandibular lymphadenopathy. Pt felt discomfort from palpation on the chin area. ![]() Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology 111(6), e15–20.) Clinical Evaluation (Diagnostic Procedures) Examinations Extra-oral Examination (EOE) (2011) Apical infection spreading to adjacent teeth: a case report. (With permission from Komabayashi, T., Jiang, J., Zhu, Q. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology 111(6), e15–20.)įigure 20.3 Radiograph after root canal filling of teeth #23 and 25. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology 111(6), e15–20.)įigure 20.2 Radiograph 4 months after root canal filling of tooth #24. ![]() Pt was transferred for further evaluation and treatment (Tx).įigure 20.1 Radiograph after root canal filling of tooth #24. Pt complained of feeling discomfort and pressure, especially when she pushed on her chin area. However, the PARL had continuously progressed ( Figure 20.3). Three days before referral, RCT of teeth #23 and #25 was completed by her second student provider. Upon follow-up, Pt reported symptoms were relieved after five days. RCT was started by her second student provider on tooth #23. The periradicular radiolucency (PARL) had enlarged to approximately 17 x 10 mm ( Figure 20.2). Teeth #23 and #25 were not responsive to Endo Ice ® and electric pulp testing (EPT). ![]() Her second student provider and the clinical preceptor found that percussion and palpation tenderness was more localized to tooth #23. Two months later, the Pt presented with severe pain in the lower front teeth. A 7×7 mm well-defined circumscribed radiolucency was seen at the apex of tooth #24 ( Figure 20.1). Six months earlier, root canal treatment (RCT) of tooth #24 was completed by Pt’s first student provider. The Pt was classified as American Society of Anesthesiologists Physical Scale Status (ASA) Class I. No known drug allergies (NKDA) were reported. No medical illnesses were reported by the Pt, and she was not taking any medication. Vital signs were as follows: blood pressure (BP) 120/78 mmHg pulse 68 beats per minute (BPM). The patient (Pt) was a 25-year-old Caucasian female. “I feel pressure and discomfort when I push on my chin.” Medical History
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