From: Valeri Stefanov
To: ROOTS
Sent: Friday, June 25, 2010 12:01 AM
Subject: [roots] Never do that - either "at home" or at your practice J

68 yrs old lady came to my practice yesterday.
A colleague of mine have made this bridge app. 2 years ago. Now all is shuttering and there is a subperiosteal
abcess of lateral incisor with pulpoperiodontitis.

You see lateral incisor after instrumentation with hand K files #06.02 up to #20.02, then HERO Shaper Difficult
Sequence set of machine files and apical third final shaping with hand K files again to # 40.02. Canal currently
is filled with paste which is a mixture of  Oleandomycin, Dexamethasone and Indometacine for one week. I will
place CaOH for another week and will afterwards finally  fill with bioceramic iRootSP. I have also prescribed her
Clindamycin per os due to allergy to several medicines including penicillin.

A perfect example what one has NOT to do :

1. Only two implants placed,  with the one supposed to replace a missing second premolar been lost two months
   after implantation
2. Instead of attempting to place at least 4 implants ( first molar, second premolar,canine on the right and
   central incisor on the left ) and leaving natural teeth alone, the colleague proceeded with the bridge you see on RX.

The treatment plan that was destined to fail from the very start.

I am now trying to save the incisors and to convert the case to a partial prosthesis, due to lack of bone and lack
of funds on patient's side for something else.

It is NOT so much about the type of implants to be used, be it even Ankylos :-).

It is about correct treatment planning and execution of the treatment. - Valeri Stefanov