From: "Guy Moorman"
To: "ROOTS"
Sent: Tuesday, November 24, 2009 6:46 PM
Subject: [roots] Bisphosphate and radiation case

68 year old female who had massive radiation to the mandible due to a
thyroid malignancy.  She had been on Fosamax long term.  She was off of
Fosamax but radiation compromised the body of the left mandible.  18 was
asymptomatic but had a large lesion on the buccal and the apex.  Tx of
choice was extraction and implant, which patient was anxious to do.  We had
the choice of 25+ visits to a barometric chamber and a shot in the dark with
extraction and implants plus risks involved in surgery in irradiated bone on
a long term Fosamax patient.

Surgeon and oncologist both wanted to save this tooth.  The decay produced
perfs into the furcation and probably down coronal portion of the distal
canal.  This had a 25 yo endo that I had done with gutta percha and ZOE.
Contamination of the apex was a given.  She was willing to give it a shot so
we removed decay.  I finished canals to length and a .08 taper.  0.10
tapered cones were placed in all canals and the MTA was packed around the
cones and the defect filled.  Cones were sheared off and a temp CSC placed.


Got her back when MTA was fully set, removed the 0.10 cones, and finished
the endo with K3s to shape apexes...40 on all canals.  The MTA was contoured
with a diamond to duplicate tooth shape and my perio guy took down tissue to
expose a 4 mm ferrule.  A well fitting temp was made to see if it would heal
and tolerate the MTA repair.  The first films were in August.  The last film
was in November.  We got a good resolution of the PA lesion in five months
so we decided to go ahead with a final crown.  I will probably place a fiber
post in the distal canal.

Sometimes we have to wing it for our patients.  The nice thing is that 30
years ago, there would have been no treatment except extraction...that was
predictable.  A small part of the margin will have to be on MTA but I think
she'll get long term use from the tooth.  She's three years in remission.
Resilon and Real Seal with System A - Guy W. Moorman, Jr. DDS





Guy, great case, properly manage given the patients medical history. I consider
this an outstanding service to the patient minimizing the possible side effects
of what the ideal treatment plan would have been. Congratulations - Jose