46: Retreatment ou extraction/implants?

The patient wants a reliable solution and I just dont think this will be the case with a retreatment bearing in mind the furcational involvement.

(J'ai deja extrait le 37 et posé un implant sur 36.

I do try to be conservative though so would you agree that trying to retreat the 46 is a waste of time?

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pgc

05/04/2014 à 14h16

Retreatment on such a teeth is a waste of time in my opinion.

sumble

05/04/2014 à 17h15

Endo. Periapical lesion treatable.

Perio. Lack of bone on the radio doesn't mean furcation exposure. To probe.

Prosthesis. Total length reduction makes me think that the tooth has overerupted, it remains probably minimal supragingival tooth substance (to be confirmed directly). Few ferrule effect + metal post + cantilever = tired root.

On a functional perspective, mandibular condyles (left bigger than right?) seem indicate left preferential chew (comparison of lateralities is essential to be sure).

So in my opinion, conservative approach could be possible(with cantilever removal) if probing and supragingival tooth substance are satisfactory.

Ps: i hope you will forgive me if my english is incomprehensible.

Sethef

05/04/2014 à 17h39

Ou amputation racine distale de 46, couronnes solidarisées 46 47 et implant 45.

Merci pour les reponses interresantes tous et merci d'avoir ecrit en Anglais ce qui n'est pas normal pour un forum Francais, mais bien appreciee.

Problem is we now have 2 (including me) for implants and 2 for conservative lol

Sumble your English is tout a fait comprehensible et beaucoup mieux que mon Francais ecrit qui est honteux. Thanks for the clear and indepth explanations.

Je serait pret pour refaire l'endo etc but I don't want to waste his or my time. Do you really think a retreatment would work? My experience gas been that as soon as there is a radiolucency at the the furcation, any endo is probably not going to work.

Sethef

05/04/2014 à 20h33

That's why hemisection is one (on many) solution.

But if you want convictions, titanium is your friend.

Latin

05/04/2014 à 21h59

First of all you should test the furcation integrity. Then if this step is ok you can carefully try to remove the IC (be carefull!). Then if the distal root is still intact, you can experiment the retreatment and wait for several months... After that you will be able to crown... or choose the titanium solution after having wasting 6 months!

chicot29

06/04/2014 à 03h00

Shoot that fuck'n molar other wise your patient will be a regular customer. Also, for only 33 euros he will get symmetric occlusion.-))

Latin

06/04/2014 à 03h13

According to its upper teeth, sure he will be a regular customer. Already "fidelised"!

I'm very conservative in my general approach of these cases, but on this one, I'd definitely take it out. Not because of the furcation (bone doesn't seem lower than elsewhere), but because of the short roots + long post in the distal (fracture risk +++) + your patient already would need an implant for the #35 (or 45 in France), just put two screws, if the patient has the means to go with it, and wants certainty.


Just my opinion though. If he absolutely wanted to keep it, it'be another debate, if he just wants it to be over with : implant.

Cheers




--
www.dentaltradegroup.com

Thanks for the replies guys (lol@ shoot that fucking molar).

If nothing else it confirms that no-one can really predict whether a reyreatment will work or not.

So it looks like we'll be saying hello to Mr T again.

nicklebenou

06/04/2014 à 21h52

Le Rosbif écrivait:
-------------------
> The patient wants a reliable solution and I just dont think this will be the
> case with a retreatment bearing in mind the furcational involvement.
>
> (J'ai deja extrait le 37 et posé un implant sur 36.
>
> I do try to be conservative though so would you agree that trying to retreat the
> 46 is a waste of time?

Extraction in my mind.

mrquentin

07/04/2014 à 01h22

because of the geometry of the lesion, i think that this lesion can be stable. is there any pain?

concerning the possibility of the retreatment, i don't see why it can't works.
but you have to probe the furcation first to see if it's involved. if the sulcus doesn't involve the furcation, you can retreat.
If you decide to retreat, the biggest challenge will be the revolving of the inlay core because of the lenght, as it was said before.
Because of the history of the teeth, maybe you should choose an adhesive solution about the post and the crown. of, cpurse, you have to wait before the crown to see if the lesion disepears