Furcation involvement class III - Courtesy ROOTS
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From: Liviu Steier
Sent: Wednesday, November 04, 2009 6:01 PM
Subject: [roots] Quiz - how would you treatment plan this case?
Terry, I like your Quiz Case very much.
I used to run a column in a UK based journal called Private Practice.
The column had the name "How would you decide?". As such I continue
myself which this kind of quizzes for education purposes. Have a look
at this case and please treatment plan. - Liviu
47 years old male in good general health.
Stopped smoking about 6 years ago.
Fair oral hygiene.
Finances are an issue.
Implant was placed about 1,5 years ago.
Vitality test negative on the following teeth:
18 / 17 26
CAP on tooth 25
Pockets over 8 mm depth:
18 / 17 / 16 / 26 / 27 / 28 / 37 / 38
Pockets over 5 mm
45 / 34 / 35 /
Furcation involvment class III
Furcation class II
18 / 16 / 26 / 27 / 28
18 / 17 / 16 / 26 / 27 / 28
- Dr. Liviu Steier, PhD
Hi Liviu, What a messy case! Lots of questions before treatment
planning that one; i.e. medical history, what drugs? etc. then a
diagnostic wax up, check out occlusion, then determine which teeth
clearly have to go and those that might have to go, re-evaluate
healing and remaining bone after extracting losers and caries
control, then final treatment planning, possibly including onlay
If finances are a problem, nothing close to ideal is possible.
I usually explain the ideal treatment planning needs to the patient
highlighting unknowns and the likely decision points along the way.
This one would be a long conversation with multiple scenarios and
paths branching off decision points. As a specialist I would hope
that the restorative dentist already had a plan that I could work
with as a template for discussion.
Teeth with questionable perio sometimes look better after adjacent
losers are extracted and initial perio therapy is implemented.
If a primary endo/secondary perio etiology is suspected on some of
the teeth (e.g.. 18, 17, 26) you might consider exploratory access
and CH placement to see if perio improvement occurs.
Given the smoking history I would presume there is chronic perio
and it's unlikely that endo disease vectors are primary.
The diseased roots likely have chronically degenerated
PDL with mature biofilm established. No money, means removables
and a path to eventual dentures. Expensive heroics do not seem
to be in the picture for this patient.
I'd venture to guess that the implant was placed to fill a hole
rather than treat the patient's disease - Terry
Hello Terry, do fully agree with you: only whole care treatment
planning is a viable solution for this case.
We have been educated and aged in this profession by performing
whole care treatments. ...but today we are "disappearing / dying
dinosaurs"! So called "minimally invasive dentistry" ( " I do not
touch because I do not know what to do!" = lack of knowledge);
"the credit crunch" = lack of financial option; "badly understood
economic competition" among dental practitioners, and last but not least
"exploding prices" in health care stopped the so called
"full mouth rehab" cases - Liviu
Liviu, This type of presentation is incredibly frustrating and
unfortunately these patients present to my office for "single tooth"
endo consultations almost every day. I really can't freakn' stand
it anymore. Ignorance is rampant, preventative care is not being
performed, idealists are being bashed for not wanted to fold into
the "extreme makeover" agenda of quick and dirty profits and let
all the malpractice bullshit fall where it may. Tort reform and
maintenance of quality health care isn't even in the dialogue for
this stupid-assed health care bill that is going to bankrupt the
USA filling the pork barrel to feed the hoodlums now
running the country.
No ethics, no quality, no brains......that pretty much describes
the current health care crisis and the misdirected focus on access
to care which is just a smoke screen to hide more
egregious pilfering of the decrepit system.
We are the last of the Mohicans and about to be wiped out by the
carpetbaggers loitering on the cherished property we pay rent and
Who is going to change the dialogue and change the world? - Terry