CASE QUIZ #17
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Thanks to Dr. Kevin Stepaniuk, DVM, DAVDC at the University of Minnesota for contributing this months quiz.
A 17 year-old F/S Siamese presented for chronically fractured maxillary canine teeth (104 and 204). The owner reported that the teeth had been “wearing down” for several years. The owner reported root canal treatments were done 10 years earlier, elsewhere. Additional medical history included previous ear canal ablation, managed and stable chronic renal failure, healed OU ulcers, and constipation. Examination identified a 2/6 left parasternal cardiac murmur.
Oral examination identified mild to moderate plaque and calculus. Teeth 104 and 204 were missing restorations and gutta percha was exposed.
What treatment options are available for teeth 104 and 204 pending intraoral radiographs?
1)Normograde retreatment of 104 and 204
2) Surgical Extraction of 104 and 204
Complete CBC/Chemistry/Urinalysis/Urine Culture and Sensitivity/Total T4 identified an elevated BUN and Creatinine. However, the elevated values were consistent with previous renal values and the renal disease was stable. A cardiology evaluation and echocardiogram identified hypertrophic cardiomyopathy as the cause of the cardiac murmur. The thyroid value was within normal limits.
Do these lab and diagnostic findings change your treatment plan options?
In order to minimize anesthesia time and associated, potential, morbidity with a prolonged anesthetic procedure for root canal re-treatments, the owner elected surgical extraction of teeth 104 and 204 (pending intraoral radiographs).
The patient was perioperatively managed for the renal insufficiency and HCM. The teeth were cleaned, and full mouth intraoral radiographs were obtained. Intraoral radiographs of teeth 104 and 204 are presented below.
What are your radiographic findings?
Tooth 204 has an underfilled obturation from the previous root canal treatment. There is loss of periapical bone. External inflammatory root resorption is present.
Tooth 104 has an underfilled obturation from the previous root canal treatment. There is severe root resorption. There is a generalized loss of bone/mineral opacity in the region of tooth 104 and the surrounding bone.
The teeth were surgically extracted and the surgical sites closed with 5-0 Poliglecaprone-25.
Tooth 204 (left) and 104 (right)