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Endo tips    Better Endo    Endo abstracts    Endo discussions

Endo perio implant algorythm - Courtesy ROOTS

The opinions and photographs within this web page are not ours. Authors have been
credited for the individual posts where they are - www.rxroots.com
From: Sergiu Nicola
To: ROOTS
Sent: Tuesday, January 19, 2010 1:58 PM
Subject: [roots] dramatic consult of the day

How would you approach a case like this (endo/implant/perio algorythm)
From my point of view this case overwhelms me.
The only complaint of the patient is esthetics (don't ask why she came to me ) 
- Sergiu

I am amazed by the variety of challeging cases in your practice - August Colpaert At any rate it looks rather good comparing to this mess. I donít know whether it makes you calm down :) - Ilya

She needs new crowns and retreatment. I would: 1) remove the crowns 2) do the retreatment/surgery 3) Every tooth that is fractured is lost obviously and needs to be replaced. 4) Create temporary crowns 5) See what the soft tissue does, when healing 6) Probably place a connective tissue graft on the buccal side of the roots. 7) pray & hope that all previous steps work out ok. - RafaŽl OMG! It will be extremely challenging to get the esthetics wright here, whatever treatment option you choose. I would go for extraction and an amazingly good implant-guy. He can then wonder upon how to deal with the bone and soft tissue loss... ;-) - Bart Sergiu, Very difficult case!!! My preliminary thoughts would be: Initial consults with perio and pros specialists so they know all their restorative and non-endo options. For the endo option 1. Remove crowns/posts and assess restorability. If not restorable or cracked then extract. 2. If teeth restorable, complete endo retreatment 3. Permanent post and cores with good temp crowns 4. Apical surgery in conjunction with periodontist to do soft tissue surgery/CT graft and any other necessary hard or soft tissue augmentation 5. Final crowns once soft tissue has stabilised Of course patient needs to have alternative options (such as that suggested by Bill Cohen) given to them with consultations at each respective specialist. I think most importantly in these cases the patient needs to have realistic expectations of the aesthetic end result because if they are expecting 100% normal soft tissue they will probably be disappointed no matter what road they decide to take. Good luck! - Jonathan thank you all for the feedback I am allready analysing the case with a very good implantologist, from my point of view those 2 teeth are out:) it seems that the grafting will be the big issue, too much of a vertical defect. I'll update this case everytime something will be done - Sergiu
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6 yr old Empress

Cvek pulpotomy

Middle mesial

Endo misdiagnosis

MTA retrofill

Resin core

BW importance

Bicuspid tooth

Necrotic #8 treatment

Finding MB2 / MB3

Deep in a canal

Broken file retrieval

Molar cases

Pushed over apex

MB2 and palatal canal

Long lower third

Veneer cases

CT Implant surgury

Weird Anatomy

Apical trifurcation

Canal and Ultrasonics

Cotton stuffed chamber

Pulp floor sandblasting

Silver point removal

Difficult acute curve

Marked swelling

5 canaled premolar

Sealer overextension

Complex anatomy

Secondary caries

Zygomatic arch

Confluent mesials

LL 1st molar (#19)

Shaping vs Cleaning

First bicuspid

In Vivo mesial view

Inaccesible canals

Premolar 45

Ortho and implant

Radioluscency

Lateral incisor

Obturation

Churning irrigant

Cold lateral

Tipped to lingual

Acute pulpitis images

Middle distal canal

Silver point

Crown preparation

Epiphany healing

Weird anatomy

Dual Xenon

Looking for MB2

Upper molar resorption

Acute apical abcess

Finding MB2

Gingival inflammation

Irreversible pulpitis

AG BU ortho band

TF Files

using TF files

Broken bur

Warm technique

Restorative prognosis

Tooth # 20 and #30

Apical third

3 canal premolar

Severe curvature

Interesting anatomy

Chamber floor

Zirconia crown

Dycal matrix

Cracked tooth

Tooth structure loss

Multiplanar curves