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The opinions within this web page are not ours. Authors have been credited for the individual posts and photographs where they are. - www.rxroots.com

Real world ENDO implant algorithm

From: "Terry Pannkuk" To: "roots" Sent: Tuesday, February 14, 2012 2:12 PM Subject: [roots] A real world ENDO implant algorithm Here's today's consult for a woman who has neglected her oral hygiene for years. I had to take out most of the CBCT images because I didn't want her name broadcasted through the social media. She finally hooked up with a quality restorative guy for a full mouth reconstruction. The usual story: patient neglect, bad restorative planning and incompetent execution dooms many teeth. I spent 3 hours examining her, reviewing the data, and writing the report for the third dentist she is now seeing. I'll probably just do the RCT on #29. Ken probably wants to talk about the color of baseballs and how cool Ankylos is; I'm trying to put another finger in the dike as the dam breaks and keeps flooding my practice with raw sewage. The endoimplant algorithm would not be so complicated if dentists could make crowns without open margins, teach their patients some oral hygiene, respect/protect quality endo, and actually spend time thinking out a strategic treatment plan. This case is what I constantly get referred,I blame a culture lacking of pride, commercially promoted B.S. polluting education and research, and greed. Any questions? - Terry Today's treatment report: Hi xxxx, I examined xxxxx. Complicated situation! Iím not sure if #18 is really #17 because thereís a lot of space between it and #20 (15.5 mm); whereas, the right side has a distance between the mesial of #31 and #29 being about 13.5mm. I donít know what her mounted models/occlusion looks like but the #15 site is severely deficient of bone (especially on the buccal aspect) so there is probably a need for some onlay grafting if you think itís worth it to replace a tooth in that area. There is only 4.8mm of alveolar bone height on the palatal aspect so the site is deficient both in height and width unless you donít mind a narrow platform implant in the palatal root area. If you think that site should have an implant then the space dilemma on the lower left becomes a complicated issue. The ridge is knife edge but two 4.0 x 8m Astraís fit with 4mm space and easily 1.5 mm clearance from the adjacent teeth. A large platform implant implant centered in that site doesnít seem to work that well. I showed the plan with two implants. If she eventually loses #18 (17) , then #20 and/or #21 you might wish the two implants werenít there. Tooth #18 seems to have no endo path but maybe it should be planned for eventual extraction anyway. What do you think? Does she need 2nd molars? My inclination is to have you refer her to xxxxxxx if you think she does, that way they can idealize the bone for #15 with block grafting, maybe distract or graft out the knife edge mandibular ridge and give her ideally what you envision as far as placements. If you donít think she needs second molars I feel very comfortable placing a 4.5 Astra in the #19 site (closer to #20), figuring we can add implants to the #20/21 sites later if necessary. Maybe you could pull #18 with some orthodontics to contact a more ideally positioned single #19 implant replacement. Tooth #31 needs to be extracted. Tooth #30 seems to have regenerated bone periapically and a the level of the accessory canal. The furcation still looks radiolucent. I could not probe a periodontal furcation defect so I suspect it might be an endo related defect (furcation accessory canal due to pulp chamber contamination). I attached some original preop radiographs of the area. The perio tissues bleed profusely upon probing and she has a lot of plaque build-up. I didnít get a CBCT of that area at this point figuring we might have more useful information if we take one later when the #31 socket is healed and can use it for implant planning. If you would like to refer xxxxxx out for advanced site preparation for the left side, it might make more sense to have xxxxxxx extract #31 and plan the right side as well. We tentatively have her scheduled to take out #31 but Kaylee can change that if wish. I also recommended endo for #29. Exam summary: 1. #15 edentulous site-deficient of bone in width and height requiring extensive grafting if an implant is placed. 2. Tooth #18: recall within normal limits and no evidence of endo pathosis. 3. #19 edentulous site: site unusual long in the mesial-distal dimension requiring occlusal assessment before implant planning, knife edge ridge not wide enough for a 5.0 platform without grafting. 4. Tooth #20: recall within normal limits and no evidence of endodontic pathosis. 5. Tooth #21: re-evaluation within normal limits and no evidence of endodontic pathosis. 6. Tooth #12: Re-evaluation within normal limits, arrested apical inflammatory resorption noted 7. Tooth #8: recall within normal limits and no evidence of endodontic pathosis. 8. Tooth #31: recall advanced caries, nonrestorable extraction advised. 9. Tooth #30: recall, severe plaque accumulation and tissue bleeding upon perio probing. Furcation radiolucency suspected to be of endodontic origin. 10.Tooth #29: Gross occlusal caries, endodontic treatment advised before restoration. Tentative Treatment Plan: 1. Decide if whether to refer out for grafting and implant planning/placements by oral surgeons (decide whether to cancel tentative appointment for me to extract #31). 2. Endodontic treatment of #29 Thanks for your trust and support, - Terry #30 Recall (#31 hopeless with caries) #8 Recall #20 Recall( I didnít treat #21 but itís fine as well) #18 Recall ENDO implant algorithm

ENDO implant algorithm

ENDO implant algorithm

ENDO implant algorithm

ENDO implant algorithm

ENDO implant algorithm

ENDO implant algorithm

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