PAGD Keystone Explorer Summer 2020

16 www.pagd.org Q dentistry issues The vast majority of cases identified as “internal resorption” are likely misdiagnosed external lesions—some that have progressed to the pulp space. Some of these can easily be distinguished with an angle-shift periapical or CBCT, but others are more difficult to distinguish. According to literature and discussions with endodontists, true internal resorption is rather uncommon. Still more uncommon is a resorptive-type lesion arising in the coronal aspect of the tooth. In the interest of brevity, please forgive the absence of the patient’s unremarkable medical history, procedural minutia, and literature citations—all of which I can share in person at future PEAK events. I realize I am no Ruddle or Rankow but as my PEAK colleagues say this is why we “practice” dentistry. Even in my short career, this group has given me the resources and confidence to enhance every aspect of my professional self. Leaders like Dr. Rick Knowlton have taught me to focus on the special relationship general dentists enjoy with their patients, which I truly believe is the best motivator for growth. A 65-year-old female patient with an existing crown about ten years old presented complaining of pain to mastication. Years earlier the patient had been referred to an endodontist for similar symptoms. A root fracture was suspected and the tooth was recommended for extraction. Clinically, the tooth showed pain to percussion and a sharp lingering response to cold. Localized pressure with a tooth sleuth produced pain, however the full coverage crown made identification of decay or a fracture difficult. A pre-procedural diagnosis of irreversible pulpitis with symptomatic apical periodontitis was made, and the patient elected to remove the crown to assess for fracture or an active carious lesion. Figure 1 Figure 2 My PEAK Presentation External Lesion Therapy Alex Frisbie, DMD