Endo OR Implant

115 Rating(s).


Posted on By ashok gowda In Endodontics

56 Yrs old lady, consulted me for an opinion. Previous Rx-History in another dental office= Root canal treatment and individual crowns for upper anteriors and bicuspids, just 4 months back. Present C/C and symptoms= Toot no. 9 (21) tender with draining sinus in the zone of attached gingiva. Her previous 4 consultations had advised her to go for extraction and implant placement, which she is not comfortable with - because its just new, invested and she does'nt want to loose her natural tooth from her jaw.

Diagnosis = C.B.C.T analysis revealed a perforation in the labial cervical region, and a poor biomechanical preparation of the root canal and obturation.

Treatment Done = Retained the same old crown. Identified the perforation with the help of magnification,and Sealed the defect with M.T.A, cleaning and shaping of root canal, calcium hydroxid dressing and obturation. Symptoms vanished and draining sinus healed. Ashok.




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11 Comments


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Hi Dr. A; This may be too much effort to keep a sinking ship. The right central has a failed endo and a poorly fitting crown. The fact that the patient spent a significant amount of money in the recent past should be a minor factor in consideration of future dental treatment especially when the past dentistry is failing. Time will tell. Regards, Gerald


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Hi Dr.Gerald, thanks and i agree with your valuable comment. Patient is now aware about the over all end result of her previous treatment and the future prognosis of those teeth and restorations. She is prepared for the future consequences, hence i took this decision and which i feel its not an over engineering. As you said time will tell. Regards, Ashok


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Ashok, I agree with Gerald that the patient will no doubt continue to spend more on trying to save what eventually will need an implant. On the other hand if she is adamant about trying to save the teeth then perhaps apicoectomy could be an option where needed and see how the patient does for 6-12 months before replacing the crowns with good margins. Even temporary crowns could help improve the fits.


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Hi Dr.Ronald, thanks for your comment. I didnt opt for apico because the existing sinus was due to the perforation in the CEJ area but not because of any change in periapical region. Once i closed that perforation with MTA and did Re - endo the tooth became asymptomatic. Regards, Ashok.


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