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Endo tips    Better Endo    Endo abstracts    Endo discussions


 Molar bridge abutment
The opinions within this web page are not ours.Authors have been credited for the individual posts where they are. - www.rxroots.com photographs courtesy: Terry Pannkuk
From: Terry Pannkuk To: roots Sent: Monday, June 25, 2012 11:36 PM Subject: [roots] 10 year heroic recall: molar bridge abutment This 88 year old male patient came back needing treatment on a different tooth, I had treated #31 very reluctantly and it was a battle to keep aseptic isolation after removing all the caries (2002). He had the minimal circumferential ferrule, but using this tooth as a distal bridge abutment was quite off the grid as far as risk assessment goes. Heís had his bridge for 10 years and is very happy with it. Thereís slight gingival inflammation but no clinical signs, radiographic, or CBCT signs of recurrent disease. Note the small as practical or as Fred would say large as practical size of the apical POEís. I have no real memory or notes about why I placed the post short but I suspect it didnít seat fully as I was in the heat of battle trying to keep isolation everything together during the build-up. If the crown margin was placed on circumferential dentin, it probably didnít matter. Today I would have placed a bonded amalgam without a post on a case like this, if I would treat a tooth like this at all! The important issue is that this tooth is functioning, disease-free, with a stabile restoration. Iíd call this a success. I treated one other tooth on this patient which I recalled as well. That recall will follow in a subsequent email - Terry molar bridge abutment

molar bridge abutment

molar bridge abutment

molar bridge abutment Wow!! What a great service for this patient! I hope he is grateful for your efforts - Fred I guess he learned to be grateful after the tooth he had treated by someone else failed after I busted my butt on the previous two. :):):) He was super nice at the recall visit last week. - Terry Fantastic save Terry!! interesting isolation, did you place the clamp on the gum and then gingivectomy and Dycal+cavit to seal? - Imran Yep, I canít imagine ideally isolating a tooth like that any other way.. On all these types of cases with no attached gingiva and miserable isolation, I donít even dream of trying to clamp whatís left of the tooth because the clamp slides, slips and the isolation is not secure. Clamping down deep on the gingiva may create a laceration, but the deeper you go the less likely you are to create a gingival defect and the deep laceration will heal. Who cares? It may not be elegant and could freak out a periodontist, but the goal is not to look pretty, itís to accomplish the objectives and be successful - Terry Amazing case ! I can't believe this kind of tooth still can be survived for over ten years. In schools, almost 100% extraction will be tx planned by any of faculties :) Excellent endo and prosth work and lucky pt!! Does he have real occlusion teeth on his maxillary arch ? Just be curious ;) - Hongsheng Hi Hongsheng, Yep, Itís his main functioning side. These cases come in periodically and I have a few that are over 20 years old. It is very satisfying to have a CBCT machine so that recall validation of proper endo technique can show the importance of classic principles leading to success. The litmus test is the long term recall evaluation not the immediate post op radiograph showing curve management Why did that compromised case I showed succeed for 10 years? Simply because: 1. I made sure it wasnít open to the oral environment when I treated it. 2. Spent a lot of time in the case recapitulating with hand files flushing with copious irrigant. 3. The cleaning and shaping phase of treatment had to be meticulous and complete or the gp cones would not have been fit with proper tug back at the apical terminus of the prep, which meant I explored the lateral walls and removed all irregularities so the cones would fit. 4. I used electrosurgery to insure the dentin margins were dry, caries control was complete and that there was a clean circumferential ferrule on dentin not some crap build-up delegated to a less concerned, less meticulous clinician. 5. and there was some luck (host defense, patientís occlusion, quality of follow-up restoration, and etc.). In summary I controlled everything I was able to control in that case creating the best odds for success. You might not be able to control everything in a case but if you control every phase of the treatment you can without compromise, you will have many successful results which seem extraordinary to other clinicians which really should be routine if we all just simply cared about giving the patient out best effort on each case. Itís humbling when I extract teeth I treated because it basically highlights my worst treatment results. I donítí get to see my best results cleared or shaved back for examination! Hereís a patient I treated this morning: This patient had the 2nd molar treated by some unknown dentist years ago. Radiographically, the root canal filling on the second molar looks like what most of us would say is good. Unfortunately, there is a 10 mm mesial pocket, furcation bone loss and periapical radiolucencies. I finished treating the first molar today. I spent a lot of time in the case I treated. I donítí know for sure but would you guess that the clinican who treated the second molar was as diligent about aseptic isolation with a dam, spent time copiously irrigating with disinfecting agents, or worried about deep apical shape? Is it Thermafilth? Is it a case with a resin sealer having jacked up radiopacifiers with cone passively floating in a septic space? J We knew the first molar needed treatment because it was symptomatic with a degenerating pulp, but what do we do with #31? It seems like the attachment around #31 has been a festering asymptomatic wound melting bone away for years. No one really noticed for decades until now. The guy who treated it probably considers this type of result an endodontic success and if it fails heíll consider it a periodontal failure. Do you really believe this is the blurry way we should view endodontic treatment results? - Terry

Protaper flaring
6 yr old Empress
Cvek pulpotomy
Middle mesial
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Bicuspid tooth

Necrotic #8 treatment
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Weird Anatomy
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LL 1st molar (#19)
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using TF files
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Tooth # 20 and #30

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