PAGD Keystone Explorer Summer 2020

Keystone Explorer |  Summer 2020  17 dentistry issues Q After removing the crown, a small (0.5x0.5mm) void was found near the distolingual line angle in otherwise solid dentin with no obvious decay. Figure 1 This defect was unroofed revealing a large lesion continuous with the pulp chamber with small tags of vital tissue. Figure 2 A CBCT suggested the lesion did not communicate with the external surface of the tooth. Figure 3 The patient was counseled on risks of endodontic therapy that the lesion may perforate the tooth beyond where we can visualize, that therapy itself may result in perforation, or that a fracture may exist below the level of the lesion. The patient elected to pursue endodontic therapy, understanding the risks of procedure and less-than-optimistic prognosis. Upon access, the lesion was found to be a “dead end” lesion prolapsing from the distolingual wall of the pulp chamber. No cracks or perforations were identified, and treatment was completed. Figure 4 A dual cure bis-acryl core material was used to seal the coronal chamber as well as the defect, the preparation refined and provisionalized. Figure 5 The patient enjoyed immediate relief of symptoms, and the tooth was monitored for several weeks with no sequelae before fabricating a new crown. Figure 6 The patient has moved out of state again, but when I called her ten months post-op she said her tooth felt great and thanked me for pursuing a creative solution for her tooth. Figure 4 Figure 5 Figure 3 Figure 6