PAGD Keystone Explorer Summer 2020

8 www.pagd.org Q dentistry issues Upon removal of the “new” temporary bridge for the next delivery appointment, the core for tooth #26 was fractured. The root canal treatment on #26 was retreated ten years ago. At this point, the dentist encouraged the patient to have #27 prepared for an abutment crown for the bridge. The patient agreed and tooth #27 was prepped, impression taken, and the temp bridge recemented on the four units. The world came to a halt with the COVID-19 shutdowns and the patient could not return to cement the final four- unit bridge. The patient needed to return home mid-March (well before the opening of the offices in Pennsylvania). The Florida dentist sent the bridge to her general practitioner dentist at home for final cementation. When the patient’s dentist in Pennsylvania re-opened and was able to see her, he attempted to remove the temporary bridge and was unable to do so using routine techniques. When the temporary bridge was finally removed, the cores that had been placed in teeth #27 and 25 were broken off and inside of the temporary bridge. In addition, the core fracture of #27 was through the pulp chamber resulting in a pulpal exposure. The RCTx on #25 was compromised and the fill was in a somewhat liquid state. The patient was informed about the situation. The patient expressed a desire to avoid having any teeth removed. Bearing in mind the recent history of these teeth, what would your treatment plan be? What if cost was a factor? What if cost wasn’t a factor? Response #1 – Carl Jenkins, DDS, MS, MAGD This case presents so many clinical challenges in addition to the personal challenges that the patient is facing. My first recommendation is that the patient needs to decide where she would like to have her dentistry done, in Pennsylvania or in Florida. The case will require time to complete successfully. If she is going to be leaving to go back to Florida I would suggest that she consider either going to Florida early to have her dentistry completed or plan to stay in Pennsylvania until it is satisfactorily finished. Sadly, I am wondering if this patient is facing more issues. It appears in one of the photos that there are additional cervical caries developing on the buccal margins of #28. Considering the patient’s age and the pattern of decay present, I suspect she may be suffering from xerostomia issues. A lack of saliva or a change in the quality of her saliva