Dental Radiographs and Root Planning
Are you taking full mouth dental radiographs of all of your patients? Are you performing an anesthetized oral exam and charting all of your patients? I know it seems like this message from us is relentless, but it is for excellent reason. Nearly everyday we discover pathology on dental radiographs we would never have known was present based only on the oral exam findings. This patient is a perfect example. He presented for a maxillary canine tooth root canal and on full mouth dental radiographs an abnormality associated with the right mandibular 1st molar was discovered. Below is a photograph of this tooth, which had a normal 1mm pocket.
After seeing this radiograph with a lucency in the furcation, creating a gingival flap to explore the area was recommended and the owner consented. Upon further evaluation of the gingiva, a very small pinpoint draining tract was also evident (marked by the dental instrument in the photo below):
A gingival flap was created over the area and after debriding granulation tissue from the boney defect this was the appearance of the tooth:
The distal root of the tooth is visible through the boney defect. After open root planning a freeze dried canine bone grafting material (Periomix -Veterinary Transplant Solutions) and a thin layer of Doxirobe were applied to the defect. A purse string suture pattern was used along the gingival margin to hold those materials in place. Finally, the area was k-lasered and the owner was instructed not allow the patient to chew on anything hard until the 2 week recheck appointment, when everything appeared to be healing nicely.