Periodontics · patient case question
Each of the following procedures is made substantially more difficult by this finding EXCEPT one. Which is the EXCEPTION?
Patient case: Bulbous root form on a recall radiograph
Patient: Male, 61 years old
Chief complaint: “Nothing hurts — I'm here for my cleaning.”
History: Hearing aid fitted last year. Reports his hat size has increased. Takes no regular medications.
Findings: Periapical radiographs show generalised bulbous, club-shaped root enlargement with the periodontal ligament space and lamina dura following the enlarged outline. The bone shows a patchy, cotton-wool trabecular pattern. Teeth are vital.
Show answer and explanation
Correct answer: A. Scaling and root planing
- A. CORRECT as the exception. Scaling and root planing works on the cervical and coronal root surface within the pocket. The bulbous cementum of hypercementosis is APICAL and mid-root, so it does not materially change instrumentation or debridement. It is the one listed procedure that proceeds essentially as normal.
- B. Root canal treatment is complicated because excess cementum obscures the true radiographic apex, making working-length determination unreliable, and apical constriction anatomy is distorted.
- C. Orthodontic movement is impaired because the increased root surface area and altered root form raise resistance to movement, and the risk of resorption and ankylosis is higher.
- D. Extraction is the classic complication. The bulbous apical mass is wider than the socket above it, so the tooth cannot be delivered along its long axis. Sectioning and surgical removal with bone removal are frequently required, and root fracture is common.