Tooth wear Management
November 26, 2025Endodontic Microsurgery
Persistent Infection from root treated 31
Mr NK, a 52-year-old male, presented with concerns of gradually shortening teeth and sensitivity to cold drinks. He also reported feeling self-conscious about his smile in photos. He is medically fit and has been using a night guard for his sleep-related grinding habit for the past year. Clinical examination revealed moderately worn dentition from erosion and attrition, along with mild crowding of the lower anterior incisors.
Virulence Factors of Aggregatibacter Actinomycetemcomitans
Virulence Factors of Aggregatibacter Actinomycetemcomitans: (Dastgir and Sohrabi 2022):- Inhibits phagocytosis
- Inhibits antibody production
- Has an outer membrane vesicles
CBCT summary of tooth 31:
- Large periapical radiolucency measuring 12.4mm at the widest width.
- Perforation of buccal bone
- Lesion involving apex of 32 and 41 (adjacent teeth)
The Key Distinctive Management for this case: The key distinctive management for this case were:
Testing the sensibility of adjacent teeth 32 and 41 (it was negative post surgery)
- CBCT was taken to examine the dimension of the lesion and surrounding structures.
- Endodontic microsurgery emphasising the complete enucleation of apical lesion, root resection, and MTA retrograde filling for optimal apical seal.
- Flap design (Papilla-based incision flap) to reduce post-operative gingival recession.
- Review after 3 months.
The patient is currently asymptomatic. As adjacent teeth 32 and 41 were non responsive after surgery, these 2 teeth are scheduled for RCT.
Pre-Operative Radiograph Tooth 31
Review in 3 months
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