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An unusally avulsed tooth

 
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Pcus



Joined: 17 May 2005
Posts: 434
Location: toronto

PostPosted: Mon Jun 19, 2006 4:41 pm    Post subject: An unusally avulsed tooth Reply with quote

In Mid March/06 my patient came back from the Orthodontist. Of course all the cement was still on the anterior teeth. the two front centrals were crowned. As I was polishing them, I noticed that the 11 (I believe it is #9) was loose. it seemed that the orthodontist moved the post, core, crown right off the root. In my attempt to remove the loose crown with my handy pneumatic crown remover, I pulled the whole tooth out of the socket. John, you may remember me telling you this when you were in Toronto in March. I have taken two post op radiographs, and everything looks pretty good, but the darn crown is still loose Since there is already Endo and a post, I cannot place any Calcium Hydroxide into the canal.

Does anyone know if there is any protocol for this situation? I need to get that crown off before the root possibly fractures, and it is possible that the root may not be in the proper orthodontic position. Like I said, it has been three months now, patient is asymtomatic, but I think the tooth still has moblitliy. I am afraid if I introduce more vibration (during the cutting off of the crown) that may compromise the healing..Is there any time frame that I should maybe not touch this thing????? I would appreciate any feedback...y
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cool kid



Joined: 12 May 2005
Posts: 818
Location: chicago

PostPosted: Mon Jun 19, 2006 4:53 pm    Post subject: Reply with quote

This is my protocol in my office for that scenario. Avulse that tooth right out of the socket again, and then put in a zimmer or biohorizon implant back in its place!!! Razz

I all honesty I would actually consider that at this point. If you can't get that crown off by cutting it and using an ultrasonic to try to vibrate that post out, you may not have a choice.
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Rich (cool kid) Rosenblatt
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Pcus



Joined: 17 May 2005
Posts: 434
Location: toronto

PostPosted: Tue Jun 20, 2006 9:30 am    Post subject: Reply with quote

I was afraid that was my only other option. I will let you know how it goes.
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john kanca



Joined: 14 May 2005
Posts: 6342

PostPosted: Tue Jun 20, 2006 9:57 am    Post subject: Reply with quote

Posts sometimes refuse to come out because the core is undercut. I would avoid any further trauma to this tooth and instrument out the post if I could. No more vibration unless it's from a bur.

I suspect an implant is in the future.
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Pcus



Joined: 17 May 2005
Posts: 434
Location: toronto

PostPosted: Mon Jul 17, 2006 2:05 pm    Post subject: Reply with quote

As a follow up for those who are interested, My re-implanted tooth is now 4 months along. Post and old crown removed, new post and core, with anchor and Simp and new crown placed. Radiograph shows no changes from original, tissue healthy, and no pockets can be probed. Patient is still in retention phase of ortho treatment, this tooth is just as stable as the others..Lets see how it goes..
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Pcus



Joined: 17 May 2005
Posts: 434
Location: toronto

PostPosted: Tue Nov 21, 2006 4:49 pm    Post subject: Reply with quote

follow up now close to 9 months, no radiographic changes, gingival tissue is perfect, tooth has normal mobility...I may write a paper on this one but I want to wait until at least a year.
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cool kid



Joined: 12 May 2005
Posts: 818
Location: chicago

PostPosted: Tue Nov 21, 2006 5:54 pm    Post subject: Reply with quote

that's awesome. thanks for the continual follow up
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Rich (cool kid) Rosenblatt
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john kanca



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PostPosted: Tue Nov 21, 2006 10:03 pm    Post subject: Reply with quote

Thanks for the heads-up!
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Pcus



Joined: 17 May 2005
Posts: 434
Location: toronto

PostPosted: Thu Aug 23, 2007 2:47 pm    Post subject: Reply with quote

My reimplanted tooth is now 17 months in the mouth. Radiograph shows
virtually no change from March 21/06 no probing no mobility....I think I lucked out on this one, since it was a endodontically treated tooth as well.
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john kanca



Joined: 14 May 2005
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PostPosted: Thu Aug 23, 2007 5:27 pm    Post subject: Reply with quote

Neat. Have a radiograph?
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Pcus



Joined: 17 May 2005
Posts: 434
Location: toronto

PostPosted: Thu Aug 23, 2007 5:45 pm    Post subject: Reply with quote

Yes! I have 5 of them since the reimplantaion...I do not have digital so I do not know how to post them..But I will be seeing you in December and I can show you the case.
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Pcus



Joined: 17 May 2005
Posts: 434
Location: toronto

PostPosted: Thu Sep 06, 2007 11:56 am    Post subject: Reply with quote

John did you get the photo's of this case I sent to your e-mail? apparently there was to much info to post on the forum.
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john kanca



Joined: 14 May 2005
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PostPosted: Thu Sep 06, 2007 12:08 pm    Post subject: Reply with quote

I did, Cus, but I haven't had a chance to convert them yet. Hang tight.
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Pcus



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Location: toronto

PostPosted: Thu Sep 06, 2007 2:43 pm    Post subject: Reply with quote

great! just wanted to make sure you got em
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Pcus



Joined: 17 May 2005
Posts: 434
Location: toronto

PostPosted: Mon May 05, 2008 3:47 pm    Post subject: Reply with quote

It has been 26 months now and my avulsed tooth looks perfect!!! boy I do not know if I am smart or lucky!
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