Hi All
I had a very interesting case today but unfortunately have no pictures to show. I saw the patient the first time on Wednesday when she was in severe pain. She had a post crown on tooth #9 that was recemented the previous day by another dentist. On the x-ray it was clear that no endo was ever performed on that tooth. I couldn’t get the tooth numbed at all. Gave her 625mg Augmentin plus 400mg Flagyl. Came in today (Saturday) and the abscess had localized above the apex of the root. I succeeded in getting it numb. Took the tooth out and drained the abscess. I found that there was a fenestration through the buccal bone at the apex level. Lots of puss drainage! I shot my Er:YAG into the socket at 350mJ, 15Hz. Nice bleeding at that point. I then used my Nd:YAG at 100mJ 10Hz to stimulate clotting and disinfect the area. I then placed freeze dried demineralized bone into the socket and a flipper plate on top. I called the patient five hours later and she said that she had no pain at all, the anesthetic had worn off and there was no discomfort at all!
One very happy patient!
I would have preferred to place the implant immediately but thought that would be pushing things a bit in this case.

Any alternative ideas on handling this?
Take care
Etienne