Abs (15).pdf

Hence such fractures must be excluded in sites with

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Hence such fractures must be excluded in sites with acute periodontal purulent infections. Figure 6(a,b) shows the presentation of an acute abscess associated with a deep probing depth at the abscessed site on a tooth which was so tender that the patient would not permit tenderness to percussion to be elicited. Table 7. Differences between periodontal and periapical abscesses, indicating which may be more likely Periodontal (more likely) ± periodontal in origin Periapical (more likely) ± endodontic in origin History Periodontal disease Periodontal treatment Previous antibiotic therapy Caries, Fracture, Tooth wear, Restorative treatment Endodontic treatment Clinical findings Vital pulp responses Periodontal probing releases pus Periodontal disease experience evident Questionable or non-responsive to pulp tests Narrow probing defect (may be isolated lesion) Advanced caries, advanced toothwear, large restorations, discolored tooth Radiographic findings Alveolar crestal bone loss, angular bone defect(s) Furcation involvement(s) Apical radiolucency, ( / ± endodontic therapy) Endodontic filling Endodontic or post perforation(s) Response to treatment Responds dramatically to release of pus, subgingival debridement Responds poorly, or not at all, to periodontal therapeutic interventions Fig. 6. (a) Abscess presenting in association with a loca- lized probing depth on the maxillary ®rst molar, which was extremely tender. (b) Crown-root fracture apparent on investigating tooth under local anesthesia. 212 Corbet
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Under local anesthesia, the fracture became appar- ent (Fig. 6b). The patient had no recollection of a speci®c traumatic event during chewing. Crown±root fractures (37) leading to acute period- ontal infections should be easy to diagnose, if no complete extracoronal coverage restoration is in place on the affected tooth or if no restoration obscures or covers the fracture line. However often the presence of restorations makes the diagnosis more dif®cult. Viewing the affected tooth with magni®cation, using either loupes or operating microscopes, it is believed should assist in the visualization of cracks/fractures extending from the supragingival environment to the subgingival environment. The bite test, transillumi- nation with a ®ber-optic light, and the use of dyes applied to the tooth in the area of a suspected frac- ture, even at the precursor stage of a crack, may all be useful if the crown of the tooth is available for exam- ination and is not obscured by restorations (1, 54). Vertical crown±root fractures, both incomplete and complete, may often be associated with an increased periodontal probing depth adjacent to the fracture (57). A ®ne caries probe or a ®ne root surface explorer may be useful in attempting to con®rm and trace the course of a crown±root fracture within the con®nes of the increased periodontal probing depth. Radio- graphs, which should be a component of the com- prehensive examination of a tooth presenting with an acute periodontal infection, are not always helpful in diagnosing vertical splits and fractures (86). It is
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  • Fall '19
  • Gingiva, Periodontitis, Periodontal Diseases, periodontal abscess

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