Of tulips and horizontal root fractures

Marga Ree is one of the most stellar endodontists in the world.  She works in the Netherlands and shares cases like these online and a courses throughout the globe.  She will be in Toronto at the George Hare Endodontic Study Club in March.

I have posted this case earlier and wanted to show the CBCT
of the 5 year follow-up.

At the age of
13 this boy sustained a trauma on tooth 11. Unfortunately, the horizontal root
fracture was treated by his dentist by performing an endo in the 2 segments.
Because of persistent complaints, the coronal segment was retreated at a dental
school,with gutta-percha and sealer. I questioned the choice of the root
filling material, it’s an illusion to think that this could have been sealed
with gutta-percha and sealer. H
is symptoms
never went away, tooth was sensitive to percussion and had a grayish
discoloration. He got the advice to have the tooth extracted.
I performed a conventional
retreatment till the fracture level, filled the coronal segment with
MTA,  raised a flap and removed the apical fragment in 2 parts, all this was
done in 1 treatment session. W
applied sodium perborate for a few days, and the access opening was filled was
with composite.
Healing was amazing, after 2 months tooth was rock solid and patient was
completely symptomfree, for the first time since the trauma took place. The last
rad and CBCT shows a 5 year follow-up. When I posted this case for the first
time, there was a lot of discussion about the poor crown/root ratio. He is 18
years old now, and he is doing fine, no complaints whatsoever. I thought it was
cool to post the CBCT, you see only one slice, but when scrolling through the
images, there is an intact PDL in every single slice!



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