Advanced perio,endo and MSD

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From: Liviu Steier
To: ROOTS
Sent: Tuesday, July 20, 2010 6:02 AM
Subject: [roots] Perio - Endo + MSD

Referred case with advanced Perio / Endo + MSD.

There is a very fine line  between "needed" and/or "doable dentistry" here,
which is very difficult  to be crossed both by patient and dentist. - Liviu Steier










what's the spirochaete lower left?
Could you give us an idea of history,  pt complaint, etc,  at the moment I have no idea what
I should be looking at. - Bill

.... the "Titanium spirochaete" is an implant! LOL - Liviu

Chief complaint of the patient:
- sporadic pain and inflammation posterior upper right  side.

Vitality test has been performed.
Perio charting has been performed (the results are obvious...).
Study casts mounted into an articulator and model analysis performed (result advanced occlusal disharmony lacking
   any functional guidance).

Treatment options:
1. Doable symptomatic treatment.
2. Needed full mouth rehabilitation.

Let us start with the "full mouth rehab" concept:
Upper jaw:
a. Either full clearence ( this would be the advise given by an Implantologist).
b. Leave upper front (very conservative treatment but with negative repercussions as any temporary restoration
   might exert novice forces and  end up with the loss).
c. Temporization for the healing time with a removable device.
d. Option 1. bilateral sinus elevation and implants ( 3 per side) plus 2 in the anterior area supporting a removable device.
   Option 2. 4-5 implants in the anterior area with a removable device.
   Where is the difference among the two options?
   Option 1 will be well sustained by the prosthetic field while slight mobility with
   option 2. Lower jaw:

Teeth 46 / 47 will need occlusal adjustments to fit the upper "ideal" occlusion
(this is why the upper will gain first attention).

Doable treatment?
Patient needs to understand all the compromises:
- Periodontal inflammation and relation to maxillary sinusitis and other  general health issues.
- Destructive occlusion and repercussions on periodontal health.
- Loss of jaw support with any further tooth loss.
- Loss of bonny support for optional later implant placement.

...but what is the doable treatment?
- Symptomatic?
- Curative?
Difficult call! - Liviu