Three cases share:
Case 1:
From this small dental film, we can see a low-density shadow, suspected to be a lesion caused by occlusal trauma. However, since there’s no occlusal trauma on the opposite jaw, the most likely source is periodontal, specifically from the lip side. Many cases like this are often due to the presence of tartar on the lip side, or perhaps after cleaning the teeth, tartar from beneath the gums was left behind, leading to the continuation of the lip-side lesion and subsequent pulp necrosis.
As you can see from this destruction, changes in the pulp have led to severe bone resorption.
So, can this tooth be retained?
It’s possible, for three main reasons.
Firstly, it’s a single-rooted tooth, which is easier to clean thoroughly without the problem of root bifurcation.
Secondly, most of the current damage is likely related to pulp necrosis. After root canal treatment and filling, partial restoration may be possible.
Thirdly, because the damage is mainly on the lip side, if the bone on the proximal and distal sides can recover, the tooth may be salvageable.
However, retaining such a tooth carries risks and isn’t without uncertainty. Therefore, initial treatment should focus on the pulp regardless of whether periodontal treatment is performed immediately or not. The root canal must be filled first, followed by observation. At this point, it’s best not to perform extensive root planing or any other procedures. Simply cleaning the root surface thoroughly is sufficient. Then, observe for approximately three to six months before considering further periodontal treatment or even bone graft surgery. If healing is not satisfactory, extraction may ultimately be necessary. Therefore, when dealing with such a lesion, comprehensive consideration is necessary.
Case 2:
In this case, everyone can see that there is such a large area of bone defect. Such a large area of bone defect, but where does this bone defect come from? Perhaps everyone’s first reaction is that it is due to a deformity, it has a deformity in the central tip. So, how should this tooth be treated? The dental specialist says that it may be derived from this tooth.
To test the vitality of the pulp, if the pulp is compromised, the pulp needs to be removed. Then, the approach to handling this lesion is reevaluated. A suggestion from the surgical specialist is that with such a large area of lesion, surgery may be necessary. Moreover, if surgery is performed, a pathological examination is required because there is suspicion that it could be a verrucous carcinoma. Given the extent of the lesion, it’s unlikely to self-heal through root canal treatment or drainage alone, according to the surgical specialist’s recommendation.
Additionally, between the surgical and dental specialists, there’s consensus that not only should the vitality of this particular tooth be tested, but also the vitality of all teeth should be assessed. Any teeth with issues may require corresponding root canal treatment. The surgical specialist advises that surgery is definitely necessary in this case. Furthermore, if it’s a verrucous carcinoma or another type of tumor, the affected tooth may need to be excised along with the tumor. Therefore, from this perspective, such a large case may require maxillofacial surgery.
It’s possible that some doctors might overlook this and only perform treatment or root planing without conducting a pathological examination, leading to irreversible changes.
Case 3:
In this case,Everyone can see that the inferior alveolar nerve canal has already deviated, and the mandible bone has become very thin. In this case, it is directly recommended to visit the oral hospital and have surgery performed by a surgical specialist.
