Tooth located on the margin of segmentally resected mandible
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°ÁöÈñ(Kang Ji-Hui) - Yonsei University Department of Conservative Dentistry
À̽ÂÁ¾(Lee Seung-Jong) - Yonsei University Department of Conservative Dentistry
Abstract
I. Objective
Discuss intervention timing of the tooth located on the margin of segmentally resected mandible and consideration factors which affect when to do the intervention.
II. Case presentation
A 22-years-old male visited our clinic because of post-operative evaluation of #36. He had segmental mandibulectomy due to ameloblastoma, Mn. Rt. 2 months ago. At the first visit, distal root of #36 was close by the surgery site and not supported by alveolar bone. #36 and adjacent teeth revealed negative response on tooth vitality tests. Treatment plan is decided to delay the intervention and do regular check-up for vitality in expectation of re-vascularization on the teeth. After then, the patient didn¡¯t come to regular check-up appointment. 3 months later, he re-visited our clinic and had done re-surgery due to post-operative infection on the surgery site. #36 and adjacent teeth still revealed negative response on tooth vitality test. With a diagnosis of pulp necrosis on #36, non-surgical root canal treatment was done. After 18 months, there were no clinical symptoms or periapical radiolucency on the tooth. Also, alveolar bone remodeling occurred around the distal root of #36.
III. Discussion
In the tooth located on the margin of segmentally resected mandible, intervention timing is a decision factor on flap survival. In this case, delayed intervention was selected because of possibility of re-vascularization on the teeth. The potential of pulp survival is related to several factors - a distance between the tooth and resection line, supporting bone around the tooth which provide delayed blood circulation to the tooth. Considered these factors, in this case, the tooth was susceptible to pulp necrosis. In addition, bacterial pathway existed on the distal side of the tooth because of loss of alveolar bone and it means the tooth was also susceptible to pulpal infection. For better prognosis of flap survival, early intervention is needed for the tooth located on the margin of segmentally resected mandible.
IV. Conclusion
In the case of the tooth located on the margin of segmentally resected mandible, intervention timing is a decision factor on flap survival. In consideration of a distance between the tooth and resection line and supporting bone around the tooth, if pulp necrosis is suspicious, early intervention is recommended.
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KMID :
1035020140150010027
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