Acute apical periodontitis and vertical root fracture of the same tooth: a case report
This summary is based on the article published in the Journal of Oral Science: Acute apical periodontitis and vertical root fracture of the same tooth: a case report
- The patient was a 75-year-old man who presented for consultation in December 2006. He was referred by his practitioner because of difficulty in chewing and an associated radiolucency in the mesial root of the right mandibular first molar.
- The patient was in good health, had no known allergies, and was a nonsmoker.
- The patient’s cardiologist prescribed 50 mg of aspirin per day as a preventive measure, due to suspicion of myocardial infarction.
- The patient brought his radiographic records with him.
- In 1984 he had been referred to dental service by his treating practitioner because of a painful AAP involving the mesial root of the right mandibular first molar. The tooth had already been endodontically treated, but the radiographic record was not available.
- Endodontic retreatment was performed (Fig. 1). A porcelain/metal crown without an inlay core was later placed, a year after the endodontic treatment.
- Follow-up radiographs at 7 and 14 years, and the absence of clinical signs during this period, indicated that the lesion had successfully healed (Fig. 2).
- In December 2006, the patient consulted his practitioner because of difficulty in chewing associated with the right mandibular first molar. The radiograph provided by the treating general dentist showed a periapical lesion involving the mesial root (Fig. 3). The patient did not report any traumatic episodes or events (e.g., mechanical stress on teeth, noises).
- Findings from visual examination were unremarkable.
- Examination of the pericoronal joint showed no evidence of any anomaly. Periodontal probing revealed a deep narrow buccal lesion along the mesial root (Fig. 4).
- Apical palpation was not painful, and no mobility was noted. Axial and transverse percussion tests were positive. Axial pressure was painful.
- Radiograph revealed a radiolucency on the mesial side of the apex, which was associated with a radiolucency observed at the furcation level (Fig. 3).
- The dimensions and topography of the lesion differed from those of the earlier lesion, of 1984, which had been larger and centered on the apex (Fig. 1).
- The new topography was strongly indicative of a crack or vertical root fracture. On the basis of these findings, various diagnostic hypotheses were considered, namely, recurring infection of the original lesion; secondary contamination of the endodontic region subsequent to coronal percolation caused by deterioration of the prosthetic junction; periodontal or endoperiodontal lesion; and a crack or vertical root fracture.
- To confirm the diagnostic hypothesis of vertical root fracture, a small exploratory flap was raised.
- Under microscopic observation (OPMI Pico Ziess, Oberkochen, Germany), vertical root fracture of the mesial root was confirmed (Fig. 5).
The decision was to proceed with a hemisection followed by extraction of the mesial root and subsequent placement of a bridge, using the distal roots of the right mandibular first molar and right mandibular second premolar as abutments.
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