Poor prognosis




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From: "Carlos Heilborn"
To: "ROOTS"
Subject: [roots] poor prognosis
Date: Fri, 29 Jun 2007 18:43:53 -0400

Here is a case where bone loss is more than evident
As the oral hygiene  and over all perio status are very good,
and the upper first molar of the other side exhibits a similar
lesion, we presume that the origin of those lesions
could be trauma due to TMD this patient is 37 yo and have a
poly cystic renal pathology, and infections must be eliminated.
Pulpal Dx was vital, and RCT was performed previously
of  Perio surgery - Carlos Heilborn



        







Hi Carlos,

Nice case. I was just wondering if the diagnosis is supposed to be Localized
Juvenile Periodontitis since the other upper 1st molar shows similar bone
loss. What about tooth nos 3.6 and 4.6? Do their radiographs show similar
bone loss? - Thomas Varghese.

Hi Carlos,

Interesting case, difficult diagnosis or differential diagnosis that determine the treatment plan:
In first term I think in Juvenile Localized Periodontitis (usually affects 1st molars and lower incisives
according to classical description), genetic involvement and 3women : 1men ratio prevalence.
When you say that your presumption diagnosis is: trauma to TMD what would you say? and based on why?
Oclusal trauma maybe? Are there frenitus? TMD I assume TemporoMandibular Disfunction, isn´t it?

About the treatment plan you mentioned Perio Surgery, what technique is planed, could you detail? - Nuria, Barcelona, Spain

Cold steel and sunshine.  you did a wonderful job of endo but not every tooth that has a canal should be treated
endodontically with the amount of bone loss (to apex on the distal of the DB root) and a large furcation involvement
the best tx IMHO would be extraction graft site and either a 3 unit bridge or an implant - Gregori Kurtzman