i guess wall-of-text posts can be quite dry. here's something a bit different.
just the other day we had a walk-in. c/o pain q2. there was some pretty extensive FP work in place, with #16-#25 as 2 bridges. #26 was unrestored, and what i tentatively labelled as #27 had the weirdest prosthodontic restoration; it looked for all the world like a pre-fab temp crown and yet had been left as a permanent restoration for 20+ years. it was in fact older than the rest of her FP work, although it was done at the same clinic. as it was tender to percussion and the patient wasn't too keen to dis-ass it and kiv RCT, i took it out there and then. sorry, no clinical pictures. what i have for you is a series based on what i did the next day during lunch time.
*note: the pics i uploaded are too damn big, please click to see until i can fix them*
just the other day we had a walk-in. c/o pain q2. there was some pretty extensive FP work in place, with #16-#25 as 2 bridges. #26 was unrestored, and what i tentatively labelled as #27 had the weirdest prosthodontic restoration; it looked for all the world like a pre-fab temp crown and yet had been left as a permanent restoration for 20+ years. it was in fact older than the rest of her FP work, although it was done at the same clinic. as it was tender to percussion and the patient wasn't too keen to dis-ass it and kiv RCT, i took it out there and then. sorry, no clinical pictures. what i have for you is a series based on what i did the next day during lunch time.
*note: the pics i uploaded are too damn big, please click to see until i can fix them*
quite a sight, isnt it? i actually asked the patient which village in china she did it in. apparently its called 'bukit timah'...
here's the buccal view. i support my claim that this was a pre-fab item made in tin or aluminium by the fact that my claw forceps could put that dent into it that you see at the gingival margin.
it even has a seam line!
a root view to let you see once again the magnificent overhangs. and just imagine, they were equigingival clinically... that weird lump of meat near the palatal root is some granulation tissue.
the suspected caries were just away from the forceps, at the distopalatal...
so i proceeded to put a bur to it...
the soft, cheap-ass metal yielded easily enough. the luting agent underneath was impressively thick, and still mostly white.
i continued to hack around the temp crown...
after prying the sucker off with a combination of ultrasonic scalers and violence, here's what it looked like. i was at first thinking that the cement may have been ZOE but it was hard as heck. might have been ZnPO4.
here's another view
i found big-ass root caries, which was probably what led to the endodontic infection
much easier to appreciate when dry.
at this point the smell was really getting to me and i chucked all the stuff. the one thing which i forgot to show about this? there was no evidence of caries or restoration of the coronal structure under all the cement!
so... why the heck did the dentist do what he did and leave it that way? i think the only possible answer is that this was in fact #28, with the #27 extracted and drifted forward. the temp crown may have been placed simply to fill the interdental space. with all that ZnPO4 within the confines of the temp crown and locking into the natural coronal bulbosities, the temp would have stayed in for all those years, while the overhangs made it impossible to do any form of proper hygiene maintenance...
the suspected caries were just away from the forceps, at the distopalatal...
so i proceeded to put a bur to it...
the soft, cheap-ass metal yielded easily enough. the luting agent underneath was impressively thick, and still mostly white.
i continued to hack around the temp crown...
after prying the sucker off with a combination of ultrasonic scalers and violence, here's what it looked like. i was at first thinking that the cement may have been ZOE but it was hard as heck. might have been ZnPO4.
here's another view
i found big-ass root caries, which was probably what led to the endodontic infection
much easier to appreciate when dry.
at this point the smell was really getting to me and i chucked all the stuff. the one thing which i forgot to show about this? there was no evidence of caries or restoration of the coronal structure under all the cement!
so... why the heck did the dentist do what he did and leave it that way? i think the only possible answer is that this was in fact #28, with the #27 extracted and drifted forward. the temp crown may have been placed simply to fill the interdental space. with all that ZnPO4 within the confines of the temp crown and locking into the natural coronal bulbosities, the temp would have stayed in for all those years, while the overhangs made it impossible to do any form of proper hygiene maintenance...
Bob Lennon - Urasawa Naoki
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