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15 year recall with recent implant - Courtesy ROOTS

The opinions and photographs within this web page are not ours. Authors have been
credited for the individual posts where they are -
From: Terry Pannkuk
Sent: Thursday, February 04, 2010 7:22 AM
Subject: [roots] 15 year recall with recent implant

I just got this patient back on recall and she finally had an implant 
replacement of the cantilever.  I didn't place it. The space looks 
inadequate a 4.0.  and the distal platform measures one-half mm from 
the adjacent molar that I treated in 1995. I took a recall PA on her 
consultation and took a CT of the tooth wanting to see how my silver 
point retreatment case was doing.  I was half expecting to see a lesion 
on the CT wondering if corrosion product sit out in the tissues
indefinitely and prevent complete osseous regeneration.  
I was pleasantly surprised with the scan, but worried that the
mesial bone is going to blow out due to close sinus proximity.  
Sometimes I get the feeling there is a cavalier attitude
that an endo treated tooth is going to be lost eventually anyway, 
so the implant was placed to protect the bicuspid at the expense of 
the molar.  Personally I think a narrow platform implant should have 
been placed. I attached the CT' captures.  It also looks like the 
mental nerve was dodged but the implant nudged out the lingual plate.   
I wonder if a CT guide was used.  I suspect it was given the tight 
space and mental nerve consideration.  It looks like a decision was
made that placing the implant close to the mesial surface of the 
molar was the least of all evils.  I would have liked to have asked 
about 20 questions of the patient but didn't want to make her 
suspicious or nervous.  Usually when I ask a lot of questions I get 
into trouble, I tend to reserve those conflicts for online. :):):) - Terry

error...meant close implant not "sinus" proximity. It's late and I'm tired. :) - Terry Great post Terry, Another cantilever would probably been fine with a rest on first premolar. Good for decades I'm sure. Another question arises. Why has he/she prepped the first premolar? I thought the Don Quixote idea was to preserve/avoid prepping the premolar. Does this person think about what they are doing? Hammers and nails come to mind. Gap=Implant=$$. As it is we now have real added risks unlike before 1 Implant failure/buccal plate perforation 2 Dehiscence of bone on Mesial of First molar resulting in premature loss. 3 Invitation to pulp death at prepped premolar. Please let me use this post as a subject of discussion in our IAAGDS (Irish Academy of American Graduate Dental Specialists). Please can you tell me also: 1. Did you miss a second canal in the D root? 2. How did you put the logo on the images document in TDO? - Danny

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6 yr old Empress
Cvek pulpotomy
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BW importance
Bicuspid tooth

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