From: Terry Pannkuk
To: ROOTS
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