on “Great Expectations”
Some time ago a restorative colleague ( n.b- he is on this list but as I write this he is probably x-country skiing in Colorado) came to me.. and to his credit he was perfectly willing to attempt something new. #31 was suppurative, extruded and bled upon probing, which as you can see, probed to the apex. The original thought was to extract, graft and replace with a fixture. He however- challenged me to use my ” magic-laser ” which to be honest, I wasn’t certain was going to do any good. I reminded him that Endodontic therapy would be indicated but he demurred.
To conceptualize this , there was no lingual plate present and unlike in an endo-perio lesion, the probing was not limited to a narrow focal point. Rather, a wide swath was accessible from buccal to lingual. The tooth was treated in 2008 and the most recent film was taken approx 1 month ago.
While it is clear that there is significant fill and from a clinical standpoint there is minimal probing on the lingual aspect of the tooth, more importantly
the tooth is solid ( no Mobility ) , probing no greater than 5mm without bleeding on the distal and has been so for a few years. Although I would have liked to see complete fill of the defect, the important part here is that he is comfortable and stable. Even assuming we only got a few more years out of a diseased tooth, how significant is that? In actuality, the recent re-eval leads me to believe that this tooth is here to stay, but that is almost beside the point.
As a periodontist who was trained on fixture placement as the ideal form of therapy- perhaps we need to re-shift our focus. We now have technology that will allow us to extend the “Dental-Lives ” of our patients, with minimal risk in terms of loss of attachment that would impede future therapies. Perhaps, if anything, the collateral benefit of these procedures is the strengthening of the attachment so that if necessary, we have more options down the road.
Left: Pre-op 2008. Probing to apex, painful to percussion , suppurative and class II mobility.
Right: October 2010. 5 mm on lingual, no bleeding. zero mobility and excellent radiographic fill. Pt is comfortable and does not even think about this tooth.
( which is a dentists best result!)
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