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Endo tips    Better Endo    Endo abstracts    Endo discussions

Furcation involvement class III - 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: 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.
Occlusal dishamony.
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 grafts etc. 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 taxes on. Who is going to change the dialogue and change the world? - Terry

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