Q: 12 and 22 has pulp exposure seen in image give me crown root pulp pdl lamina dura and bone findings A: Based on the clinical photos and radiograph provided, here is a structured findings report for teeth 12 upper right lateral incisor and 22 upper left lateral incisor using FDI notation: --- Clinical & Radiographic Findings — Teeth 12 and 22 Clinical Photo Findings Both 12 and 22 show Ellis Class III crown fractures — fractures involving enamel, dentin, and exposing the dental pulp. This is visible as the reddish pulp exposure point at the fracture surface. --- Structured Findings by Component Crown Feature Tooth 12 Tooth 22 --------- Fracture type Ellis Class III — oblique/horizontal crown fracture Ellis Class III — crown fracture Extent Enamel + dentin + pulp involved Enamel + dentin + pulp involved Pulp exposure Present red/pink tissue visible at fracture surface Present red/pink tissue visible at fracture surface Discolouration Yellowish-brown crown discolouration suggesting chronic caries/staining Same Root Feature Findings ------ Root length Appears adequate — roots visible on radiograph, likely fully formed mature apex Root fracture Not evident on the available radiograph — no radiolucent fracture line seen traversing the root Root morphology Single-rooted, conical — consistent with upper lateral incisors Pulp Feature Findings ------ Pulp chamber Appears narrowed/obliterated on radiograph — consistent with pulp calcification or the radiographic effect of the crown fracture Pulp canal Poorly visible on the radiograph — may indicate calcific metamorphosis or the oblique angle of the film Pulp status clinical Exposed — direct pulp exposure confirmed clinically; likely symptomatic irreversible pulpitis or early pulp necrosis given the discolouration Periodontal Ligament PDL Space Feature Findings ------ PDL width Appears within normal limits around the mid and apical thirds on the radiograph — no gross widening Lateral PDL No obvious lateral PDL widening to suggest lateral luxation Apical PDL Appears widened at the apex — suggestive of developing periapical periodontitis from pulpal involvement, though the image quality and angulation limit definitive assessment Lamina Dura Feature Findings ------ Tooth 12 Lamina dura appears intact along the lateral walls; indistinct/disrupted apically — suggesting early periapical pathology Tooth 22 Similar pattern — lamina dura partially visible, with possible loss of definition at the apex Note The dark/overexposed apical region on the radiograph makes precise lamina dura assessment difficult at the apex Supporting Bone Feature Findings ------ Crestal bone Alveolar crest appears present between the incisors; no obvious gross horizontal bone loss Periapical region There is a suggestion of periapical rarefaction reduced bone density at the apex of both teeth, consistent with early periapical inflammatory lesion — possibly periapical granuloma or early abscess formation Cortical plates Not fully assessable on this periapical film Interradicular bone Normal trabecular pattern where visible --- Summary Diagnosis Both 12 and 22 present with: - Ellis Class III crown fractures with frank pulp exposure - Radiographic evidence suggesting pulp necrosis / irreversible pulpitis with early periapical pathology widened PDL space and periapical rarefaction - No radiographic root fracture identified Recommended Management 1. Immediate: Pulp extirpation root canal treatment for both teeth is indicated given pulp exposure with likely necrosis/irreversible pulpitis 2. Crown: Full coverage restorations crowns post-RCT given extent of tooth loss 3. Endodontic: Working length determination, canal preparation, and obturation 4. Periapical follow-up: Radiographic review at 6 and 12 months to confirm periapical healing Note: The radiograph is taken at an angle appears tilted and displayed with blue illumination, which reduces diagnostic precision. A properly angulated, high-quality IOPA intraoral periapical radiograph is recommended for definitive assessment of the PDL space, lamina dura continuity, and periapical status. Classification reference: Ellis fracture system — Rosen's Emergency Medicine, Class III = pulp-exposing fractures requiring urgent endodontic evaluation
