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Iffy tooth - Courtesy ROOTS

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The opinions within this web page are not ours. Authors have been credited for the individual posts where they are. Photos courtesy Mark Dreyer- ROOTS

From: Mark Dreyer
To: ROOTS
Sent: Monday, September 18, 2006 7:11 PM
Subject: [roots] Iffy tooth

One of the first referrals from this doc.  Not sure if he'll be impressed
and send stuff before he messes up next time, or just send me more of this
kind of stuff after the snafu.  Probably the latter.

If I was tx planning the restorative I wouldn't have used this tooth as a
bridge abutment.  I would do a single unit crown and implant the edentulous
space.  However, this doc will do a bridge.  I informed the patient my opinion is
guarded prognosis long term.  Let's see what happens - Mark

wonder if her perfed it before or after he separated the file - Dr Huq Mark: Neat recovery of SI. You're getting pretty good at getting these out. how long did it take to fish it out? but you really can't afford a reputation for removing SI's.....))) I agree with you about not using for a peer abutment of a fixed bridge, but on its own, should last a while - ahmad Ahmad, This one took me probably 30 minutes to get out. Yup, I sure don't want much more experience doing this. I love the feeling pulling that file out, but other than that, it's not a fun task - Mark Nice work, Mark .. what do you use to capture the SI in the tube cyanoacrylate? - Simon Thanks, Simon. I used chemically cured resin core buildup material - Mark Mark, Nice job. It would seem to me that you carry significant weight regarding the final restorative plan due to your endodontic experience and the microscopic view you had during the procedure. You are intimately tied in to the overall success of this tooth. If you personally would not use this tooth as a bridge abutment in your own mouth, then that is what you should convey to both the patient and the referring dentist. If the referring DDS does not want your restorative input, then it is my opinion that you are better off not working with this kind of dentist. Although it would be nice to impress a new referral, I think you may be right that he’s the type that will continue to send this kind of trainwreck, so you might as well give your opinion now and let the chips fall where they may. If he’s a solid operator he will value your opinion. If he is a schmuck, he will never refer to you again and you’ve saved yourself a boat load of future crap referrals. - Rod Rod, Some of the teeth that get referred to me, get sent back with no tx. In this case, I wasn't sure it was abolutely contracindicated to use this tooth as a bridge abutment. The patient will go to a periodontist for c-l surgery, so who's to say, this tooth may function quite well. I advised that the implant would be more predictable, but this was a retired military guy and he had it in his mind that he wanted to keep this tooth for a bridge and I didn't see it as absolutely contra-indicated, only mildly so. My staff will tell you that I send away as many cases as I take on-I really get some iffy stuff sent my way. Had one yesterday in which there was a failing root canal, but there was 90% periodontal bone los on the distal-out of here! - Mark Mark, I get a lot of iffy stuff too. I suppose it comes with the territory. Ultimately, all we can do is make a restorative recommendation after we have treated or choose not to treat in the first place. I’m with you I turn many compromised cases away. I hate failure. Some guys treat by prescription. If its got a circle on the referral slip it gets an endo, and they couldn’t care less how it is restored - Rod Rod, Mark's restorative view should carry even more weight since he practiced restorative dentistry for so long. I agree with Mark. I know this would not be a bridge abutment in my practice. All restorative would involve implants. I always go with endo first but hate bridges even without the iffy distal abutment. With the advent of implants that are so predictable, bridges should be a last resort. This tooth may function well as a stand alone but it would never be the distal abutment of a bridge in my practice today. Personally, I would take Mark's advice as the gospel. Guy Guy, What if you were the treating endodontist here? You did the endo under magnification, repaired the furcal perforation and know exactly how compromised the tooth is. You do not believe with your knowledge and experience that this tooth will serve well as a distal bridge abutment. You wouldn’t treat it that way if you were restoring it and you wouldn’t use it as a bridge abutment if it were your own mouth. You are now sending the case back to this new referring GP who is planning on doing a fixed bridge here. What do you say? How do you handle it? - Rod I would advise the referring dentist that the tooth was repaired but would have a very guarded prognosis as the distal abutment of a FPD. I can see this tooth standing alone restored with some success. As a bridge abutment I see it only as a hazard. But, Rod, I'd also have to admit that with the advent of predictable implant restorative...in the hands of a good surgeon and a good restorative dentist...no weekend wonder GP, I have little faith in bridges. I think implants should be considered where ever possible. Part of this view is the tremendous disappointment that I have when I see a bridge come in that has been loose on one end for several months and you've lost a cuspid or other vital tooth. I also admit that I do tend to forget the hundreds of successful bridges that I've placed. I think this is one reason surgeons are so down on endodontics. They only see the failures...not the millions of successful cases. This tooth simply does not have a good long term prognosis as a posterior bridge abutment. Standing alone it may do OK and I'd give it a shot. I'd tell the referring dentist all of this before treating the tooth an put part of the weight on them. If I had someone like you treating the tooth, as a referrer I'd tell you to fix it and we'd go with it as a single unit. Guy