dental practice July 2009
Robinson’s Referrals
www.dental-practice.org
Case 53
CPD
Brett Robinson BDS PhD FDSRCS MBA DipED ILT
Senior Lecturer and Honorary Consultant, Department of Primary Dental Care,
King’s College London Dental Institute
T
HIS 18-year old patient was discomfort. Intra-oral examination percussion in either the horizontal or
referred because of the revealed no restorations other than vertical planes. There were no
development of a “lump in the fissure sealants for most of his restorations in these teeth. However,
mouth” opposite his upper left canine posterior teeth. palatally 22 showed a distinctive deep
(23). He had noticed it for about two There was gingival inflammation pit surrounded with pronounced
months and claimed that it was not (Figure 1) particularly involving the marginal ridges and a cingulum filled
changing in size. There was no history papillae, with bleeding on probing. with material alba (Figure 2).
of trauma. Basic periodontal examination showed A trimmed gutta percha point (ISO
He reported no pain but had been scores of up to 2 (plaque retentive size 30) was inserted into the sinus and
aware of a slight “throb” in the region factors present, no pocketing more a long cone orthoradial periapical
FIG 1
of 23. However, about five weeks than 3.5mm) when measured with a radiograph taken. This revealed a
previously antibiotics had been WHO 621 probe. significant roughly circular-shaped
prescribed and these “seemed to put There was an erythematous swelling periapical lesion with a well-defined
the problem right.” with a sinus located buccally between periphery about 14mm in diameter
He was in the last stages of 22 and 23 on the alveolar mucosa close centred on the apex of 22 (Figure 3).
orthodontic treatment which had been to the mucogingival junction. There Lateral incisors are commonly
active for about two years and visited was no palatal involvement. Initial associated with developmental
his dentist regularly. His medical vitality testing with Endo Ice (Roeko) anomalies. In 1-2 per cent of the
history was unremarkable and he did showed that 13 , 12, 11 , 21, 22, 23 and population it is missing from the dental
not smoke. 24 were vital. arch. It is not uncommon for it to be a
FIG 2
Extra-oral examination demonstrated There was caries on 11 cervical to rudimentary cone-shaped “peg” lateral the palatal aspect through the
no facial asymmetry or facio-cervical the orthodontic bracket and (a further 1-2 per cent of individuals). substance of the tooth to become a
lymphadenopathy. However, pressure demineralisation around brackets on The cingulum may be crossed by a type of dens invaginatus. 12 also
below the left nostril caused some TePe_DenPrac_112x155_922_09.pdf 25/3/09 19:06:07other teeth. No teeth were tender to groove which may be fissured and showed an identical deep foramen
extend onto the root surface. cacumen.
Some lateral incisors have a sharp The vitality testing with Endo Ice
distal dilaceration at the apex was reappraised since according to the
® complicating endodontics and radiograph 22 should show a negative
extraction. Rarely as in this case the response. Endo Ice at -26.2
o
C can be
foramen cacumen extends deeply into applied with a cotton wool pellet as
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16
DP July 09 8, 10, 12-20, 22.indd16 16 24/6/09 16:46:51
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