“Books and Covers” read: When Not to Judge

Hi:

When I met this patient almost 3 yrs ago the first thought that went through my mind was ” Why would anyone try and save this tooth ( #18 )” ? Not only was the existing restoration “poor” to say the least, the tooth required endodontic therapy ( if even possible ), had 2+ mobility and was suppurative to percussion. Forget the furcation involvement. Most importantly, the fellow belonging to this mandibular left 2nd molar was at the time -87 years old.

As I was debating ( in my ” inside voice” ) how to tell him delicately that I didn’t think it prudent for him to follow through with any treatment other than extraction- he gently chided me and said ” Don’t look at me as an old man- I don’t look at myself that way.” That was the AHA! moment that I’m certain every one on this list has had at one time or another…the moment when we realize that what we want is not necessarily what the patient wants- or needs. ( within reason of course). To which he concluded ” They are all mine, and I would hate to lose my first tooth at this age.”

To that end, I offered  to treat the area including the adjacent tooth with LPT ( LANAP ) and hoped for the best. Another sign from above that should have told me that this was going to work was that the gentleman left immediately after the procedure to Vermont for the annual ” college roommate w/wife/s reunion weekend ” which had been a tradition for 63 yrs.!..

The rest is straightforward with a few interesting points to ponder. Firstly, the distal root seemed to be calcified and  the widened pdl space tells us clearly that there is an occlusal component to this particular case. Indeed, the tooth was hitting significantly on the wrong cusp and the distal marginal ridge..This was adjusted at the time of surgery. And again, and again and again. But, no endodontic therapy was performed and the symptoms have abated at least until this point. Very Surprising.

Standard LPT protocol was followed and follow-up w/ occlusal adjustment were performed for 1 yr. The final film was taken in May of 2010 just shy of 36 months post-op. Patient, Tooth and College Room-mates are all doing very well. The tooth in question has 0 mobility and probings are wnl…

As always, I look forward to your comments and if there are cases that you would like to share with the group, send them to the above email and we will take it from there. As always, if shown you will get full credit for your work.

Finally- and I am sending this out as a test balloon to both Lanaper’s and Non Lanaper’s alike- Would there be interest in a lecture/ dinner/ ce course with a more formal presentation on LANAP? If there is enough of a critical mass, I will gladly arrange it. There are some excellent speakers out there willing to share.  It would probably be mid-winter here in NYC. For those that already do the procedure- there could be a case conference where people present their own cases and dialogue with the group. For those not yet familiar or more interested in just getting their patients’ to the right place, not necessarily doing the procedure themselves- a much more in depth talk focused on the possibilities and capabilities of LANAP  as a modality of periodontal care will be arranged.

Let me know….and Keep on Healing,

Neal

Left: pre-op june 2007. Tooth was mobile, suppurative and as well note the
areas apical to #19. This tooth was not symptomatic but nonetheless was treated at the same time.

Right: May of 2010- almost 3 yrs post-op. Pt is now 89 yrs old and his teeth are going strong.
Note the bone fill on the distal root of #18 and the return to
“normal ” of the pdl space around said root.

Pt is comfortable and reports no symptoms. Mobility has all but disappeared
and there is no significant pathologic pocketing.
#19 seems to have re-trabeculated as well.