Sunday, August 9, 2009

Warning (This blog may be utterly boring!)

Looking at dental radiographs may be something that is of no interest to readers of this blog and if so please skip this entry.  Yet I am aware of dental professionals that read this blog and might find this case of interest.  I personally find it quite remarkable and beyond my imagination that it could be accomplished in rural Africa; but I understand if your interest does not match my own.

This patient a 56 year old Kenyan male physiology teacher came to me with a loose crown on tooth #8 (or 1-1 pr Kenyan numbering system).  He had  a healthy dentition and was willing to attempt anything to keep his tooth and refrain from moving towards a denture or implant (not currently available at Kijabe).  

The patient had the crown and post placed on tooth #8 about 15 years previous. The tooth was asymptomatic beyond the crown being loose.  You can see from the x-ray a radiolucency around the margins of the crown (reoccurent decay) and a post that is short, 3 mm long (10-15 mm is ideal or to within about 5 mm of the apex). 

Our plan included removal of the PFM crown #8.  Removal of the post without perforation or fracture of the root.  Removal of the Gutta Percha to within 5 mm of the apex.  Shaping the canal appropriately for post placement.  Placement and cementation of a new para-post.  Fabrication of new PFM crown.  

Below you will see the progress that was made.  The PFM crown was loose and easily removed.  Patient was anesthetized with Septocaine.  The decay was 360 around the CEJ of the tooth and subgingival. It was removed with SS burr. The Post was lightly vibrated out of the canal with the Pro-Ultrasonic Piezo Electric Unit (thanks to a generous donation from Tulsa Dental).  The GP was removed with the Tulsa Dental Rotary Gutta Percha removal files to within 5 mm of the apex.  The canal was prepared for a post with the red parallel post rotary drills.  A red para-post was placed and cemented with max cement.  The core was built up with core composite material and cured.  Gingival Retraction cord was placed x2 and hemodent was used in addition to attain a dry field for impression.  Light body and Heavy Body PVS impression material was used for a final impression using a quick bite tray.  The tooth was temporized with a prefabricated acyclic crown and lined with trim.  Cemented with dycal.

The  patient returned in two weeks. The crown was fabricated and a dental laboratory in Nairobi. Margins, occlusion, and fit was checked and the crown was cemented with GIC.  

The patient was well pleased with the shape, shade, and function of his newly restored smile.  We talked at length about how pleased he is to come to Kijabe Mission Hospital for dental and medical care.  I don't believe that he is a man of faith yet he described this hospital as a placed filled with "heroes."  He said the "nurses and doctors go beyond the normal care.  They are courageous, talented, and dedicated."
Perhaps a small recognition that Kijabe exists to go beyond physical care, but also to allow the divine to find a presence in his life.  


Anonymous said...

Great post Malin. I appreciate learning about dentistry through this kind of information. Keep 'em smiling and keep teaching them about the love of Jesus.

Hope Sara is healing and the girls are happy.

Bend, OR

hankwillisdds said...

Good service, Malin, especially considering the resources.

In the way of constructive criticism, I would have recommended retreating the entire root canal as a preventive measure. It can undoubtedly be argued that the circumferential caries likely recontaminated the gutta percha (we all know GP leaks). It does appear that there may be some widening of the PDL of #8.

Dan Hayward said...

Keep the technical posting coming, Malin!
One of your climbing buddies, Justin, is getting married in 2 months.
Thanks for blogging.

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