 |
 | Home | Contact Us | FAQ | Search & Site Map | Link to Us |
 | Sign In | Join | Other 45 Sites in Network |
Medical Forum / General / Dentistry / September 2005LR1M: Intrusion or Extraction?
Howdy all. This first set is all the same: One xray of our hygienist's father's lower right first molar. I copied all four of the TinyPics so you can choose whichever is most convenient: <img src="http://tinypic.com/bgqz49.jpg" alt="Image hosted by TinyPic.com"> http://tinypic.com/bgqz49.jpg [IMG]http://tinypic.com/bgqz49.jpg[/IMG] http://tinypic.com/view/?pic=bgqz49 The way I see it, it's either exo and implant (after we control the perio between those teeth) or we send him to the ortho to try and push it back down. I don't know how long it's been like this (I've only seen him once) and I don't know what is going on with the lucency in the furcation either (whether it's active perio, a Fx'd tooth or whatnot). I asked, but none of the dentists he's visited seemed to find that tooth bothersome..... Somebody even put the filling on it recently. I note that the tooth is restored with an MO Am with what seems to be Am core inside it. I have a photo of the tooth as well: http://tinypic.com/bfgd2x.jpg His daughter told him to come to see me beause I am T.H.E. Great Dentist. I had to tell him that I'm not sure how to proceed, but that we definitely cannot leave the situation like that and risk undermining support of the teeth on either side. I was thinking fast intrusion and hope that the bone stays at the same level. Once down in the normal position, of course, I can only see an attachment between the three teeth to stabilize the situation. This could be two MonoDont metal parts intra cononally, extra coronal wire or Maryland bridge metal cemented on the buccal... None of this would be necessary of we do an implant, since AFAIK, implants are not active in the bone (they won't extrude). This is what Alex V was saying before: they actually use them as anchors to pull teeth around the mouth, since they don't move. He has some dental insurance, so we can do at least some work (we'd send off an estimate and see what they'll cover). If anybody has any thoughts or comments, I'd appreciate hearing them. I'd also appreciate knowing which of the first links are useful and which aren't. Thank Youse SP  SignatureTake out the TRASH to reply As expected I am here at DentalCom.Net (http ~ Joel344) and I am observing two of the radiographs. If I were at Forte Free Agent (nntp ~ Joel M. Eichen), I would have to click to follow the link which I might be less inclined to do if I were a patient. DIAGNOSIS: Chronic periodontitis. TREATMENT: 1. Explain the condition thoroughly and obtain "Informed Consent" as to explanation of the disease process. 2. Offer perio options either in-house or at the specialist. Preferably the latter. 3. Chop that puppy down big time, and create a beautiful crown that is in line with the plane of occlusion. This should be installed by next Thursday or Friday. 4. Complete the case with an upper three-unit bridge to prevent the puppy from extruding again. EXPLAIN this all to patient to avoid lawsuits! Believe me, people forget quickly including hygienists and their fathers. Joel M. Eichen DDS Joel SignatureJoel344 About periodontal prognosis: This is often described as, "Gournished Helfen case." This is well-described in the periodontal literature -- Joel34 Control perio first. Prognosis for this tooth is very guarded due to furcation involvment and super-eruption. After perio... re-evaluate restorative options but this tooth more than likely will not be a survivor. Flap http://flapsblog.com Yes I agree. Poor prognosis. Better off with control of perio problem and extraction with implant follow up http://maloms.tripod.com >Yes I agree. Poor prognosis. Better off with control of perio problem >and extraction with implant follow up > >http://maloms.tripod.com I guess ..... how many implants and what type of superstructure/restorative procedures? GUESSTIMATE of costs ....... The patient's demographics ........ Will this happen? Or are we just pontificating again? In this profession I hear pontification 90% of the time, and practical treatment 10% of the time. This brings up a philosophical point. I do hope other dentists an netizens will join in. FURC or no FURC, meaning bifurcation o trifurcation, that is, the area where the trunk of the tooth split into two or maybe three roots. FURCATION The place where something divides into branches Yeah but it sounds weird. If its my tooth and it do not hoit, -then as long as its still ther and not loose I want a nice level crown on it. My philosopy is a crudd tooth is still better than a beautiful implant. Why? I can always ge the implant later on. Do not worry, I hate the casinos and most likel will not lose my dough before I need the implant. DOC: "But in the long run its a goner." PATIENT: "Yeah so true. Come to think of it in the long run we is al goners." Joel Flap Wrote: > Control perio first. > [quoted text clipped - 8 lines] > > http://flapsblog.co -- Joel34 >Control perio first. I am not sure it will help. That's a clinical decision the treating doctor must make, after informed consent of course. I would prefer to see valuable resources go into a lower leveled crown plus an upper three-unit bridge. That will give the patient some chewing power and perhaps slow down the natural process that will eventually loosen these teeth. These teeth are never going to become the teeth of an 18-year old. Patients do not understand this ... mainly because we FAIL to tel lthem. We pretend that the "COMPLETER MAKEOVER" Dr. Dorfman, etc. will fix it up. WRONG. Joel This is the GOURNISHT HELFEN diagnosis that is widely quoted in periodontal research circles. >Prognosis for this tooth is very guarded due to furcation involvment >and super-eruption. [quoted text clipped - 5 lines] > >http://flapsblog.com Original Post: On 1 Sep 2005 08:32:06 -0700, "Flap" <fullosseousf...@gmail.com> wrote: >Control perio first. I am not sure it will help. That's a clinical decision the treating doctor must make, after informed consent of course. I would prefer to see valuable resources go into a lower leveled crown plus an upper three-unit bridge. That will give the patient some chewing power and perhaps slow down the natural process that will eventually loosen these teeth. These teeth are never going to become the teeth of an 18-year old. Patients do not understand this ... mainly because we FAIL to tel lthem. We pretend that the "COMPLETER MAKEOVER" Dr. Dorfman, etc. will fix it up. WRONG. Joel This is the GOURNISHT HELFEN diagnosis that is widely quoted in periodontal research circles. >Prognosis for this tooth is very guarded due to furcation involvment >and super-eruption. >After perio... re-evaluate restorative options but this tooth more than >likely will not be a survivor. >Flap >http://flapsblog.com Flap's Reply: But, Joely you have to control the perio and be true. Because if you are not true to your teeth they will be FALSE to you. If you cannot control the perio then look at more extractions and removeable prosths. Flap http://flapsblog.com > If you cannot control the perio then look at more extractions and > removeable prosths. > > Flap This is true, but I don't think the perio will be hard to control, especially once the lowere first molar is eliminated. The lower wisdom tooth on that side is also gonna take a vacation. Thanks SP SignatureTake out the TRASH to reply This brings up the current dental hygienist nonsense that we dentists have come to buy ...... hook, line, and sinker. Breaking up biofilm ..... disturbing bacterial colonies ....... scooping out bacteria with our little currettes ....... big bucks for us doing scaling and root planing ...... Can't we be on commission? Look at patient demographics and epidemiology! Sorry Marty, the hygienist! If you worked for me I would never say a word. I'd have no beef with you doing your thing. Hey! Want a couple of days work in Center City? It would be fun. Joely >> If you cannot control the perio then look at more extractions and >> removeable prosths. [quoted text clipped - 7 lines] >Thanks >SP OK I will be TRUE and 'fess up. Flap did not write the first few paragraphs. I did. Falp wrote ....... (Flap wrote) ...... >If you cannot control the perio then look at more extractions and >removeable prosths. > >Flap REPLY: I disagree with that. If teeth are rock solid as they often are with horizontal bone loss (this is conjecture here, this is only one x-ray), a dentist is being foolish if he thinks he is helping people by injudiciously remobving teeth! That beautiful removable partial denture you make today is DESTINED to become a full denture over time. The dentist is hastening the process! My theory is not m,ore and more procedures ....... its more and more people WHO DO not resort to full dentures. In Pennsylvania of the over-65 population, 32% are completely edentulous! One out of three has NO TEETH at all! That's called, TOO MUCH DENTISTRY! DISCLAIMER: This is not always so. Each case must be diagnosed based upon its own merits. Sometimes selective extractions are the best therapy. This may be so with SP's case here. Joel >Original Post: > [quoted text clipped - 45 lines] > >http://flapsblog.com > DISCLAIMER: This is not always so. Each case must be diagnosed based > upon its own merits. Sometimes selective extractions are the best > therapy. This may be so with SP's case here. True enough; it MAY be best to extract, and it MAY not. I told my Hyg lady that I really would appreciate seeing his past xrays to see just what the scenario is with that frucation involvement we see on the 'ray. Is it new? Or has it stabilized like that since long b/4 Moses?. If this is so, W_B and others' suggestion to just lop it off and put a bottle cap on it would be entirely appropriate. This is of course providing that the perio on the mesial of that tooth is also controllable easily. I understand what you mean by weakening remaining bone structure by exo'ing indescriminately; it's like cutting out all the trees on a hill except one and hoping that one tree will hold the ground in place, and that the ground will hold that one tree in place.... That said, haven't you ever made the clinical observation that often, the gums are doing poorest around extensive obturations, less unhealthy around crowns (especially the well adapted ones) and BEST of ALL around implants???? It is as if the soft tissue likes hugging implants better than it likes hugging natural teeth... From that point of view, I want to stick an implant in there as soon as possible, manage the adjacent bone, and get that all done BEFORE he needs extensive bone rebuilding and also BEFORE he retires and loses his means to pay for the thing. Thanks SP SignatureTake out the TRASH to reply >From that point of view, I want to stick an implant in there as soon as >possible, manage the adjacent bone, and get that all done BEFORE he [quoted text clipped - 3 lines] >Thanks >SP Sorry dude, quit trying to be the healer of all things. Keep it simple, those treatment plans mostly work. -- W_B wubbabubbazG@RBAGEyahoo.com Take out the G'RBAGE > Sorry dude, quit trying to be the healer of all things. > > Keep it simple, those treatment plans mostly work. > > -- > W_B 'K... will go up to the mountain and converse with the gods. Thanks SP SignatureTake out the TRASH to reply > About periodontal prognosis: > > This is often described as, "Gournished Helfen case." > > This is well-described in the periodontal literature. LOL! Steve SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 Tough case. Either JME's suggestion of cutting into good occlusal plane Ext and 3-unit bridge Leave it alone. Treat the perio, and consider what is planned for the upper arch. >Howdy all. This first set is all the same: One xray of our hygienist's >father's lower right first molar. I copied all four of the TinyPics so [quoted text clipped - 47 lines] >Thank Youse >SP -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com > http://tinypic.com/view/?pic=bgqz49 > > The way I see it, it's either exo and implant (after we control the > perio between those teeth) or we send him to the ortho to try and push > it back down. I don't know how long it's been like this (I've only seen > him once).... blah... blah... blah... Thanks for all your thoughts. My own feeling is that if we don't do an implant now, he will lose bone fast and we'll lose the ability to do one down the road, when he has no more insurance. The idea of a three unit bridge up top is good, and I wonder if I wouldn't be better off starting there, lopping off a bit of the lower first molar to get good occlusion, and then inserting the bridge. In the meantime, we'd control the perio and finally extract the lower first molar. Then we can afford to let the bone heal up well without danger of the upper teeth extruding into the space. Thanks again. SP SignatureTake out the TRASH to reply >> http://tinypic.com/view/?pic=bgqz49 >> [quoted text clipped - 6 lines] >implant now, he will lose bone fast and we'll lose the ability to do one >down the road, when he has no more insurance. Insurance covers what part of this? > The idea of a three unit >bridge up top is good, and I wonder if I wouldn't be better off >starting there, lopping off a bit of the lower first molar to get good >occlusion, and then inserting the bridge. Go for it. I would grind off half the crown and then deepen the occlusal surface leaving a trough along the perimeter. Then fill the entire occlusal with composite and carve the occlusion exquisitely! Joel > In the meantime, we'd control >the perio and finally extract the lower first molar. Then we can afford [quoted text clipped - 4 lines] > >SP > >Thanks for all your thoughts. My own feeling is that if we don't do an > >implant now, he will lose bone fast and we'll lose the ability to do one > >down the road, when he has no more insurance. > > Insurance covers what part of this? We won't know that until we fire off an estimate to his insurance. Don't forget, this is Kaaannnadda. Coverage is less quality than all-a youse get down yonder. > > The idea of a three unit > >bridge up top is good, and I wonder if I wouldn't be better off [quoted text clipped - 6 lines] > > Joel Do you mean leaving a buccal and lingual trough to be retentive for the composite or what? Don't forget it is only an MO Am. Also, don't forget that I will etch the Ammmmal-gam with (what else?) the Danville Mark IIA fully autoclavable microetcher. This will give good mechanical retention into the Am for the composite. Another thing would perhaps be just to carve out the occlusal of the Am and the enamel at a lower level. If this thing really is an Am core, it will be thick enough to have that done with not much problem. Thanks SP SignatureTake out the TRASH to reply >> http://tinypic.com/view/?pic=bgqz49 >> [quoted text clipped - 16 lines] > >SP Not a bad approach. -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com >The idea of a three unit >>bridge up top is good, and I wonder if I wouldn't be better off >>starting there, lopping off a bit of the lower first molar to get good >>occlusion, and then inserting the bridge. In the meantime, we'd control >>the perio On second thought why not just stop here. Put a good fuji 9 base, and restore with composite. tooth already has endo, so no chance of pulpal exposure. >>and finally extract the lower first molar. Then we can afford >>to let the bone heal up well without danger of the upper teeth extruding [quoted text clipped - 8 lines] > >W_B -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com > On second thought why not just stop here. > Put a good fuji 9 base, and restore with composite. > tooth already has endo, so no chance of pulpal exposure. I'm thinking because of the Perio between the 1M and the 2PM in front of it. The angle of the 1M and the furcation involvement scares me. Remember this patient is fifty years old and is in tip top physical shape (he runs Masters' level bike races). So he's gonna be around chewing hard tack at ninety years old... I don't think this tooth will hold up till then, whereas I think a well-placed implant _will_. Of course, as JME said before, procrastination/indecision will be his worst enemy here. This is why, if he decides to go the implant route, I will send him to a generalist I know who plants them. He has a reputation for doing the strict minimum of tissue procedures (which take forever to heal up) so as to get the thing functional in a reasonable bone and soft tissue in the shortest possible time frame. Thanks SP SignatureTake out the TRASH to reply >> On second thought why not just stop here. >> Put a good fuji 9 base, and restore with composite. [quoted text clipped - 6 lines] >chewing hard tack at ninety years old... I don't think this tooth will >hold up till then, whereas I think a well-placed implant _will_. This is such bullshit. Numb all quads, fire up your ultrasonic and get all of the calculus off of *all* of the teeth. No hygienist, do it yourself. come back next 10 - 14 days and re-eval. You are putting the cart before the horse. >Of course, as JME said before, procrastination/indecision will be his >worst enemy here. This is why, if he decides to go the implant route, I >will send him to a generalist I know who plants them. He has a >reputation for doing the strict minimum of tissue procedures (which take >forever to heal up) so as to get the thing functional in a reasonable >bone and soft tissue in the shortest possible time frame. Blah, blah, blah.... Treat the periodontal disease. Restorative comes later. >Thanks >SP -- W_B wubbabubbazG@RBAGEyahoo.com Take out the G'RBAGE With dentistry as with bathroom remodeling the first ticket is to "kno your customer." This is increasingly difficult as people bounce aroun from dentist to dentist. By this I mean to ask certain open-ended questions and listen as to ho people respond. Some people want a basic job to prevent the food fro sliding up between those teeth and others, well you would be astounde as to what people request. I have had patients who desire chin implants, everything ... and the have the money and the desire for follow through. Conversely, one astute patient came in and told me, "...nothing fancy Doc, just a good basic job." Oh boy that saved s many words! Joely Joel M. Eichen DDS aka Joel aka Joel344 aka "The Closer." ..humor on that last one .... THIS IS NOT sales, although it almost appears that way! Joely PS While trying to figure out how to spell a word that I had to exchange out because I could not figure out how to spell it, I came across another old-time favorite: slivovitz DEF. Hungarian plum brand -- Joel34 > I have had patients who desire chin implants, everything ... and theyhave > the money and the desire for follow through. [quoted text clipped - 5 lines] > > Joely JME, I sincerely appreciate what you and W_B and the others are saying to me. My gut, my nose and my little finger tells me PUT IN BONE SCREWS THAT WILL LAST TILL THE NEXT COMING OF BOB. See the reply to W_B and think about it. I do thank you both especially for forcing me to solidify my position. Cheers SP SignatureTake out the TRASH to reply REPLY This is the value of SMD and now DentalCom.net, www.MedKB.com and all the others too numerous to mention. Often, the choices are not clear cut. It is still your decision in the long run and your responsibility as well. So here are a number of dentists, patients, interested people who can chimne in and suggest this or that. Some good ... some bad .... ALL USEFUL! Other dentists, lurkers, Rod Kurthy, anybody even Howie Farran can read this over and think "there but for the grace of Bob, go I." Joel >> I have had patients who desire chin implants, everything ... and theyhave >> the money and the desire for follow through. [quoted text clipped - 16 lines] >Cheers >SP > REPLY > [quoted text clipped - 7 lines] > > Some good ... some bad .... ALL USEFUL! Exactly. As I said, you all have forced me to defend and solidify my own position. > Other dentists, lurkers, Rod Kurthy, anybody even Howie Farran can > read this over and think "there but for the grace of Bob, go I." Too true. I don't think Howie would deign to appear here though. Bob be with you. Thanks SP SignatureTake out the TRASH to reply >> Other dentists, lurkers, Rod Kurthy, anybody even Howie Farran can >> read this over and think "there but for the grace of Bob, go I." > >Too true. I don't think Howie would deign to appear here though. That would be a hoot! Joel >Bob be with you. > >Thanks >SP > >Too true. I don't think Howie would deign to appear here though. > > That would be a hoot! > > Joel I would bet more on the rumor that Jesus Christ got down off the cross way back when... SP SignatureTake out the TRASH to reply > >> On second thought why not just stop here. > >> Put a good fuji 9 base, and restore with composite. [quoted text clipped - 8 lines] > > This is such bullshit. Ach, Laddie.... Glad yew think so.... >Numb all quads, fire up your ultrasonic and > get all of the calculus off of *all* of the teeth. > No hygienist, do it yourself. > > come back next 10 - 14 days and re-eval. Six weeks for re-eval in what I've learned. The way you present this, the perio will be all but cured. Period. I know this is not the case and so do you. The guy will not come down from Chicoutimi every three months to detoxify that booby trap between the two teeth. I know it in my bones. If I sink two implants into that mug, they may just be the last two teeth in the posterior quadrant in twenty years' time, after the other natural teeth have been maintained,,, maintained,,, maintained,,, until they just fall out of existance. Check it out in your own patient's mouths: when you screw a patient, it lasts. When you cap them it is more iffy perio wise. Aren't you the one who warns about putting crowns and bridges on natural teeth before root canals? The upper 2M will have the sh.t cut out of it so he could have a bridge in line with the upper 2PM. All this would be sitting on crappy bone and root quality. I don't have the stomach to do that. Add to it the cost of four-canal Endo, and you are damed near a price of a unitary implant anyway. Even more so if you decide to get them both done together. > You are putting the cart before the horse. Maybe, but I don't feel like doing operative and FPD on a swamp. What you all have said to me has been very beneficial, even if I choose to recommend another Tx that what you and JME have suggested. I'm gonna see him this week and recommend U/L single implants. If he says 'No', I'm gonna have him sign it in the dossier and it's caveat emptor re: Vitality of the upper 2nd Molar and the perio between the lower 1st molar and its anterior neighbor. He'll sign that too. If I could, I would refer him down to Wershington and let you all perform on him. Thanks for solidifying my position. SP SignatureTake out the TRASH to reply 1. extract 2. implant I'd have a tight chest trying to successfully intrude the beat-up tooth. > Howdy all. This first set is all the same: One xray of our hygienist's > father's lower right first molar. I copied all four of the TinyPics so [quoted text clipped - 47 lines] > Thank Youse > SP > 1. extract > 2. implant > > I'd have a tight chest trying to successfully intrude the beat-up tooth. I phoned my referring Ortho and she said the same. Thanks SP SignatureTake out the TRASH to reply > The way I see it, it's either exo and implant (after we control the > perio between those teeth) or we send him to the ortho to try and push > it back down. I suggest you simply cut the tooth down to normal height and recontour it. It has endo, so you don't have to worry about the pulp. Reshape it to what you want to restore it to. Add some composite if you have to. Leave it this way for a few days as a diagnostic effort. If all is well, do a full crown, 3/4 crown, or onlay. Signature/ Amatus / > Howdy all. This first set is all the same: One xray of our hygienist's > father's lower right first molar. I copied all four of the TinyPics so [quoted text clipped - 47 lines] > Thank Youse > SP > > The way I see it, it's either exo and implant (after we control the > > perio between those teeth) or we send him to the ortho to try and push [quoted text clipped - 5 lines] > this way for a few days as a diagnostic effort. If all is well, do a full > crown, 3/4 crown, or onlay. Well, this is a variation of what W_B and JME and others were saying, and I _still_ feel that it will end in tears after this patient loses his insurance. However, it could be a plan B. Next time I see him I'll discuss the options. I still feel that a crown on the lower and a bridge on the upper is a second class treatment. Thanks SP SignatureTake out the TRASH to reply This is the old problem .... I have had patients with teeth, not great teeth but teeth and their Chief Complaint (C.C.) is ..... they are losing their dental insurance and want all their teeth out and dentures ..... NOW! I can't do it! Joel >> > The way I see it, it's either exo and implant (after we control the >> > perio between those teeth) or we send him to the ortho to try and push [quoted text clipped - 16 lines] >Thanks >SP >I _still_ feel that it will end in tears after this patient loses > his insurance That may well be the case, but it is not your burden. Don't get overly involved with trying to be the hero for your staff's family. Trust me, they will still leave you without adequate notice the first time someone else offers them $0.50 an hour more than you are paying them. Treat the case well, and treat it properly, but don't sweat over getting them Rolls Royce level of care just because the daughter works with you. Do the work in stages and do the best they will let you do. Signature/ Amatus / > >> > The way I see it, it's either exo and implant (after we control the [quoted text clipped - 20 lines] > Thanks > SP > >I _still_ feel that it will end in tears after this patient loses > > his insurance [quoted text clipped - 6 lines] > level of care just because the daughter works with you. Do the work in > stages and do the best they will let you do. Will comment on this tonite when I have time. Dear Bob but I am sick of being poor.... SP SignatureTake out the TRASH to reply >>I _still_ feel that it will end in tears after this patient loses >> his insurance [quoted text clipped - 6 lines] >level of care just because the daughter works with you. Do the work in >stages and do the best they will let you do. Good advice. -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com > >>I _still_ feel that it will end in tears after this patient loses > >> his insurance [quoted text clipped - 13 lines] > Take out the G'RBAGE > wubbabubbazG@RBAGEyahoo.com If you look at that xray again, you will see that the mesial of the lower 1st molar is in bad shape and the interdental space is in a state of permanent perio disease; even a full osseous flap with apical repositioning will not eradicate that. So, cutting down that tooth doesn't adress that problem, whether or not we crown it or just Fuji 9 it or composite it or whatever. Would you not agree? My next point was that implants tend to be better perio risks than natural tooth roots are. Others have said this, and I seem to have seen this in those few patients I have with implants (done by others, not by myself). Therefore, this would be a better cost outlay in the long run for this patient. Would you not agree that it is the case that implants tend to last longer in an alveolar bone than natural teeth? And, assuming that the resting potential of a nerve fiber is 70mV (inside negative) , and implants can dissipate electrical potential into the surrounding chewing gum, and if I shoot 350mV across an implant and..... GOOD BOB!!!! What am I saying??!?!?!?!?! ;-) SP SignatureTake out the TRASH to reply >If you look at that xray again, you will see that the mesial of the >lower 1st molar is in bad shape and the interdental space is in a state [quoted text clipped - 13 lines] >Would you not agree that it is the case that implants tend to last >longer in an alveolar bone than natural teeth? I would have to look at the film again to answer these questions. >And, assuming that the resting potential of a nerve fiber is 70mV >(inside negative) , and implants can dissipate electrical potential into >the surrounding chewing gum, and if I shoot 350mV across an implant >and..... Then you would be KPW's cousin. -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com >I would have to look at the film again to answer these questions. Oops, forgot to say: please repost the link. -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com > >I would have to look at the film again to answer these questions. > > Oops, forgot to say: please repost the link. > -- Yes, I caught that. Here is a copy of my original chicken scratchings: Stovepipe <stove99pipe@yahoo.ca> wrote: <img src="http://tinypic.com/bgqz49.jpg" alt="Image hosted by TinyPic.com"> http://tinypic.com/bgqz49.jpg [IMG]http://tinypic.com/bgqz49.jpg[/IMG] http://tinypic.com/view/?pic=bgqz49 ------- and the photo of the tooth: http://tinypic.com/bfgd2x.jpg Thanks SP SignatureTake out the TRASH to reply >I would have to look at the film again to answer these questions. I must be dense. I don't see the infrabony defect on the PAx. I see bone level with where the CEJ's would have been if the tooth had not super-erupted. I still say, shorten the tooth. Signature/ Amatus / > >> >I would have to look at the film again to answer these questions. [quoted text clipped - 23 lines] > Thanks > SP > >I would have to look at the film again to answer these questions. > > I must be dense. I don't see the infrabony defect on the PAx. I see bone > level with where the CEJ's would have been if the tooth had not > super-erupted. I still say, shorten the tooth. OK... as said, I'll propose this option to him, but I will remind him that his insurance won't last forever. Thanks SP SignatureTake out the TRASH to reply >> >I would have to look at the film again to answer these questions. >> [quoted text clipped - 7 lines] >Thanks >SP Nothing lasts forever. Be sure and make that patient an NTI. -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com > >OK... as said, I'll propose this option to him, but I will remind him > >that his insurance won't last forever. [quoted text clipped - 10 lines] > Take out the G'RBAGE > wubbabubbazG@RBAGEyahoo.com That goes without saying. Thanks SP SignatureTake out the TRASH to reply >>I would have to look at the film again to answer these questions. > >I must be dense. I don't see the infrabony defect on the PAx. I see bone >level with where the CEJ's would have been if the tooth had not >super-erupted. I still say, shorten the tooth. Agree. -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com > >>I would have to look at the film again to answer these questions. > > [quoted text clipped - 4 lines] > Agree. > -- It isn't infrabony. I was not right about that. It is just really shitty architecture as far as perio goes on the mesial of that blessed lowere 1st molar. SP SignatureTake out the TRASH to reply >> >I would have to look at the film again to answer these questions. >> [quoted text clipped - 11 lines] >Thanks >SP After re-examining this case I still don't think that you would have a persistant perio problem between 29 - 30. Cut that sucker down. BTW that's not the prettiest endo, but it'll likely work. -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com > After re-examining this case I still don't think that you would > have a persistant perio problem between 29 - 30. OK. > Cut that sucker down. sigh...... OK, that's what we'll suggest. > BTW that's not the prettiest endo, but it'll likely work. > -- Agreed. But, as I say, it seems to be an amalgam core/post, and so getting through that to redo the Endo would be out of my capabililties, I believe. > W_B > Take out the G'RBAGE > wubbabubbazG@RBAGEyahoo.com Thanks again. If nothing else, this case has gotten me on my bike late at night and caused me to get some exercise: I do better thinking when I'm pumping the ol' patatoe (heart). SP SignatureTake out the TRASH to reply >> > The way I see it, it's either exo and implant (after we control the >> > perio between those teeth) or we send him to the ortho to try and push [quoted text clipped - 16 lines] >Thanks >SP Agree to disagree... The above treatment will most likely work, with the least amount of trouble. -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com |
Reply to this Message |
 Sign In
 Join
 My Latest Posts My Monitored Threads My Blog My Photo Gallery My Profile My Homepage Start New Thread Enable EMail Alerts Rate this Thread
|
©2009 Advenet LLC Privacy Policy - Terms of Use
This website includes both content owned or controlled by Advenet as well as content owned or controlled by third parties.