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636
Figs 1a and 1b Patient 1. Clinical photograph and standard
periapical radiograph taken at the patients first visit (2 weeks after
thermal injury). (a) Note the severe gingival recession with inflammation and exposure of the labial alveolar bone on the maxillary left
central incisor. (b) Internal root resorption and thin residual dentin
was also present.
Case report
Patient 1
637
with denudation of the labial alveolar bone was noted, and the patient was referred to the hospital.
Intraoral clinical examination
revealed localized severe gingival
recession on the labial aspect of
the left central incisor associated
with labial alveolar bone exposure
(Fig 1a). There was a 2 4-mm
gap between the cementoenamel
junction and the alveolar bone
crest. The height of the denuded
alveolar bone was 3 mm. Internal
root resorption was observed using periapical radiography (Fig 1b).
Root coverage was performed using a subepithelial connective tissue graft on the day of the visit.
Surgical procedure
A laterally positioned flap comprising a subepithelial connective
tissue graft was used for root coverage. After papilla preservation,
consisting of a horizontal incision
and two vertical incisions, a fullthickness flap was elevated (Fig
1c). The outer surface of the denuded alveolar bone was carefully
removed using a root-planing bur.
After preparing the recipient site,
free connective tissue was obtained
from the left palatal area (Fig 1d).
The connective tissue was trimmed
and placed on the exposed root
and alveolar bone bed (Fig 1e).
The outer flap was positioned laterally to cover the grafted tissue and
was sutured with 4-0 monofilament
using the single interrupted suturing technique (Fig 1f). Sutures were
removed 10 days after surgery.
Wound healing was uneventful. The patient was recalled for
follow-up at 1 (Fig 1g) and 3
months (Figs 1h and 1i) after surgery for postoperative care. The
denuded area of the maxillary left
central incisor was completely covered up to the cementoenamel
junction at 1 month after surgery.
Patient 2
Discussion
The vertical condensation technique allows thermoplasticized
gutta percha to be homogeneously packed without leakage using
a heated plugger. However, the
safety of this device cannot be
guaranteed if the operator is not
aware of its correct use. Studies
evaluating temperature changes
within the root canal caused by
various devices that are used for
vertical condensation have found
that these devices can increase the
temperature of the surrounding tissue by 4C to 14C.58 Therefore,
the heated plugger used for canal
obturation may carry with it the risk
of transferring noxious heat to the
root surface, particularly if the dentin wall is thin. It is recommended
that the residual dentin thickness
be assessed at the radiographic
examination before treatment begins. If there is internal resorption
within the root or if the dentin
thickness is less than 1 mm, the risk of
heat transfer should be considered.
The timing of surgical intervention may be critical for the prognosis of the injured tooth. Cases
of thermal injury similar to those
presented have been described
previously. Gluskin et al9 reported
a case in which a tooth injured by
an ultrasonic device had to be extracted 2 days postinjury as a result
of persistent discomfort. Following
extraction of the tooth, the remaining alveolar ridge collapsed, shrank,
and was esthetically compromised.
In another case, a central incisor
was thermally injured by an ultrasonic device10 and although several
638
Figs 2a and 2b Patient 2. Clinical photograph (above) and
standard periapical radiograph (right) demonstrating acute gingival
recession and exposure of the labial bone 10 days after canal
obturation. Note the thin dentin in the apical region.
Fig 2c Denudation of the labial bone persisted at the 5-week
recall visit following thermal injury. The patient was referred to the
Department of Periodontology, and root coverage was performed
on the day of examination.
a
b
Fig 2d Following flap reflection, the
outer surface of the exposed bone was
removed.
Fig 2e Connective tissue was placed
and immobilized on the root and the
bone.
Conclusions
Acknowledgment
The use of a heated device during
endodontic treatment is associated
with a potentially high risk of periodontal tissue damage, and therefore, special care should be taken
This study was supported by a faculty research grant from Yonsei University College
of Dentistry in 2010 (6-2010-0100). The
authors reported no conflicts of interest related to this study.
639
References
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2. Eriksson A, Albrektsson T, Grane B, McQueen D. Thermal injury to bone. A
vital-microscopic description of heat effects. Int J Oral Surg 1982;11:115121.
3. Eriksson AR, Albrektsson T. Temperature
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tissue injury: A vital-microscopic study in the
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4. Eriksson RA, Albrektsson T. The effect
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