Introduction
In children, immature teeth ie teeth with incompletely formed roots or root apex, are commonly seen in children. In such teeth, endodontic treatment if required, has to be done in stages. Single sitting RCT is avoided and treatment takes a typically longer time. It is important that parents of the child are thus counselled in this fashion.
- Name: Shagun
- Nick name: Shagun
- Age/Gender: 8 yrs/female
- Place of birth: Gajraula
- Address: Gajraula
- Parent’s occupation: Father is a teacher
- Religion: Hindu
- Family income: INR 60,000/month
Case Report
An 8 year old female patient reported to the clinic, with the chief complaint of on and off pain in upper right and lower left back tooth region since 20 days.
Patient was completely asymptomatic 20 days back then she experienced pain in upper right and lower left back tooth region which was spontaneous in origin, intermittent type and patient required medicines in order to relieve the pain.
Nothing relevant was reported in pre-natal, natal and post natal history.
On extra oral examination, no abnormality was detected in hairline, skin, eyes, nose, ears, lips, nails, lymph nodes and TMJ.
On intra oral examination, a grossly decayed lesion was seen in 16. Deep carious lesions were seen in 26 and 74 and incipient carious lesion was seen in 75. Vestibular tenderness was seen with 74 and vertical percussion elicited pain. The dentition was mixed dentition, with a Class I molar and canine relationship. The overjet and overbite could not be predicted as 11 and 21 are in the erupting stage. No abnormality was detected on soft tissue examination.
- Deep dental caries irt 26, 74Teeth present-mixed dentition
- DMFT score – 2
- DMFT score - 2
- DMFS score – 4
- DMFS score - 3
- Stains/Calculus - +/+
- Grossly decayed irt 16
- Deep dental caries irt 26, 74
- Vertical T.O.P. +Ve irt 74
- Vestibular tenderness present irt 74
- Initial caries irt 75
- Molar relationship - Angle’s Class I molar relation bilaterally
- Canine relationship - Class I canine relation bilaterally
- Overjet and Overbite - cannot be predicted as 11 and 21 are in the erupting stage
Provisional diagnosis was chronic irreversible pulpitis in 16, chronic periapical abscess in 74, and dental caries in 26 and 75. The diagnosis were confirmed with radiographs. The radiograph revealed a radiolucency involving pulp and incomplete root formation in 16.
Investigation:
- Intra oral periapical radiograph irt 16,26, 74 and 75
- Radiograph revealed radiolucency involving pulp and incomplete root formation irt 16
- Final Diagnosis
- Chronic irreversible pulpitis irt 16
- Chronic periapical abscess irt 74
- Dental caries irt 26, 75
Treatment Plan
For the emergency phase, an extraction was performed for 74. Amoxicillin (250 mg B.D. for 3 days) and Ibuprofen (200 mg, S.O.S.) were prescribed.
For the preparatory phase, oral prophylaxis was performed and oral hygiene instructions were given.
For the corrective phase, revascularisation/apexogenesis was done, followed by cementation of stainless steel crown for 16. Caries excavation and review was done in 26 followed by stainless steel crown. A GIC restoration was placed in 75. A band and loop space maintainer was given for the extracted 74. The patient was kept on periodic recall and follow up every 3 months.
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