Iatrogenic Damage during Molar Extraction?

[Brause]

This is actually a case of pattern recognition. It appears that part of the mesial root of tooth 47 was "clipped" during the extraction of tooth 46.

What's the clinical significance of this "small root surface defect"? I present different images from different dates, 2 before the extraction of tooth 46, and two thereafter.

It appears that the panoramic, taken immediately after the extraction, aligns with the most recent CBCT scan from last week. The images prior to the extraction do not show any root surface defect.

The radiologist interpreting the latest CBCT scan from 2 May 2024 writes:

" A small root surface defect is noted along the mesial aspect of the middle third of the mesial root of tooth 47. No signs of periradicular bone loss or pulpal communication are present. This defect may reect a localized focus or external resorption or be iatrogenic in nature.

Mild apical periodontal ligament space widening is noted on tooth 47, which could represent a normal variant or an early sign of endodontic pathology. Note that the periodontal ligament space around the root circumference of tooth 47 is also slightly widened, which is likely related to occlusal trauma. There are no specic signs of a root fracture associated with tooth 47."

 

[Dr M]

In a case like this, I would observe the 47 for now. There is a chance of external root resorption taking place. If the tooth is symptomatic, a root canal can be attempted with MTA placed in the region of the defect. MTA has been shown to have massive success in root perforations, so might be indicated in a case like this as well.

 

[Brause]

MTA = Mineral trioxide aggregate?

 

[Dr M]

Correct