xray of bottom molars bottom molar with a side growth

This recent emergency patient just had the restoration on his molar placed about four days prior to seeing me. He was complaining of pain and throbbing in the gums around the tooth that had been treated.

He stated that the doctor who placed the restoration had difficulty getting him numb when the onlay was bonded to place and had to give him “lots of shots.”

There's a lot going on around this one tooth. So, what do you see and what do you think is the cause of the necrotic tissue on the facial? Why is the pain occurring? What do we do about all of this?


Post a Comment

Comments

Commenter's Profile Image Eurico Martins
July 9th, 2012
Wow! Is this an overdose of vasocontrictor which essentially "torniqueted" that area of gingiva and killed the tissue?
Commenter's Profile Image Paul Ganucheau
July 9th, 2012
I agree. Too many pdl injections caused the localized necrosis. What is the pulp status of the tooth? Extremely hypersensitive to cold? The widening of the pdl near the crestal bone makes me think mesial-distal fracture.
Commenter's Profile Image Steve
July 9th, 2012
You both got it. Too much septocaine for an isolated area. It just sloughed over the weekend and is now healing nicely. What else is going on here that could be contributing to his pain? The area that was necrotic was not painful.
Commenter's Profile Image Mark Olson
July 9th, 2012
Heaps of excess cement and/or calculus...open distal contact?...
Commenter's Profile Image Jon ( Mark's Classmate)
July 10th, 2012
Rubber dam clamp
Commenter's Profile Image Kay
July 10th, 2012
This whole mess looks so rediculous. I can only imagine how the patient and tooth were handled from the prep through the cementation. Remove the restoration, remove all the cement, temporarily restore and schedule for a new patient exam. How you handle the other dentist is the biggest question here.
Commenter's Profile Image Kevin
July 10th, 2012
High occlusion? It could also be the way the tooth was prepped and how the restoration was bonded.