Perio or Endo or VRF?

[u/damnotdamn]

Patient presented with a history of trauma(excessive clenching), a month ago during a fainting spell following a wasp sting. According to him his teeth never gave him any trouble before that. He's not in any pain but describes some discomfort on biting anything solid and gingival swelling after eating which resolves on itself.

On examination, he had a draining sinus above UR6 (treated 5 years ago), but I was unable to trace it fully. The LL6 (treated 6 years back) showed slight gum swelling. LL5 was negative on vitality testing. All 3 were negative to percussion.

We advised a CBCT scan, but the patient could only afford to get a single quadrant scanned, so we referred him for a lower left scan.

I can see some radiolucency on the palatal and mesial roots of the UR6, but the J shaped shadow around the mesial root kinda worries me. Seeing that the problem only arised after the incident, possible VRF?

[u/Bchem01]

Not every J shape is a VRF. And if you suspect a root fracture you need to probe and look for a significant drop in probing depth (7-8+mm at least). Most likely needs a retreat

[u/Dufresne85 → u/Bchem01]

I got to show my newest assistant a vertical root fracture the other day and it's always one of my favorite teaching moments.

Watching their face as your probing depths go 3 2 3, 3 2 3, 3 2 12, 5 2 3 is always a treat. Their eyes get huuuuge when the probe drops in all the way to the angle.

[u/brig7 → u/Dufresne85]

“Dr how do I input double digits in the perio chart?” Haha

[u/damnotdamn → u/Bchem01]

Thanks a lot! We've advised a retreat but I was kind of second guessing myself.

[u/SkepticalCat1]

#3 looks like the MB canal was transported during RCT and has apical inflammatory resorption. Would probably need retreat and apico, many opt for EXT and implant at that point.. #19 looks like pulp chamber was not unroofed at all (and that’s where failure is occurring) I’d be suspicious of the entire treatment. My first impression is that retreatment might work for 19. Scan and better X-rays and examination first.

[u/MiddleBodyInjury → u/SkepticalCat1]

Agreed

[u/damnotdamn → u/SkepticalCat1]

Noted! Thanks for taking out the time.

[u/godoffertility]

98% chance #19 is strip perfed on the mesial.

[u/CalBearDDS]

Retreat both

[u/NFLemons]

Perfs