Dental Tribune U.S. Edition

Dental Tribune U.S. Edition | February 2012A4 cliNical ARThuR GolDSTEIn, DDS, has been in private practice in the Principality of Mona- co since 1963 in general den- tistry, periodontics, prosth- odontics, oral surgery and dental implants. Prior to that he was an instructor in operative dentistry at the Royal Dental College of Den- mark, Aarhus, Denmark. He earned his DDS at North- western University School of Dentistry, Chicago. He is the founder and president of the International Academy of Ra- diosurgery and is a fellow of the International College Of Dentistsand a fellow of the American Academy of General Dentistry. Office: +377 93302850. Mobile: +377 (0)607933868. Web: www.dragoldstein.com,dragoldstein@monaco.mc. By Arthur Goldstein, DDS Case history Mr. H presented in my office in an emer- gency situation with pain that had begun several days prior in tooth #27. The pain was no longer relieved by analgesics, and sensitivity had begun in the right sub mandibular area. Clinical examination The #27 tooth had a class IV occlusal distal amalgam restoration of long date. There did not seem to be secondary car- ies. There was no apparent decay in the tooth, which was very sensitive to light percussion. There was also sensitivity in centric occlusion, which dissuaded the patient from closing his teeth together. Radiographic examination Radiographic examination revealed a large area of internal resorbtion apical to the gingival crest (Fig. 1). Treatment Mr. H. was given three grams of amoxi- cillin and 400 grams of Spifen and in- structed to take two grams of amoxicil- lin six hours after the procedure. A right mental foramen block local anesthetic of articaine Hcl with adrena- line was given. A full-thickness periodontal flap incision to bone with a Colorado electrode and Ellman Dento-Surg™ Radiosurgical unit set to “cut” (fully rectified filtered current) was performed to gain access to the area of internal resorbtion (Figs. 2, 3). The area of resorbtion was curetted, followed by a root canal treatment with a gutta percha cone and estesone sealer (Fig. 4). The lamina dura at the apex of the root was not defined (Fig. 4). A base of ZnPo4 cement was placed over the cone in the area of the resorb- tion, followed by a well-polished macro composite filling. The periodontal flap was closed with Ethicon #5 non-resorb- able sutures (Fig. 5). The #27 tooth is seen one-week post op in Fig. 6 and one- month post op in Fig. 7. Mr. H did not wish further treatment of the #27 tooth. Figs. 2, 3 Radiosurgery provides access to area of internal resorbtion. Ad Radiosurgery used to access internal radicular resorbtion Fig. 1 Radiograph shows large area of internal resorbtion apical to the gingival crest. Photos by Dr. Arthur Goldstein Fig. 4 Resorbtion is curetted, followed by root canal treatment with a gutta-percha cone and estesone sealer. Lamina dura at apex of the root is not defined. Fig. 5 Periodontal flap is closed with Ethicon #5 non-resorb- able sutures. Fig. 6 One week post-op. Fig. 7 One month post-op.