P.E.T complication and management

109 Rating(s).


Posted on By Ehab Moussa In Failures

Hello friends,

This is part of a perio-posthetic treatment for this patient. Patient presents post a failed RST (root submergence technique) attempt for #7. Management included complete post removal, further root and osseous reshaping and a rotated palatal pedicle to obtain primary closure. Photos show the 4 week post-op healing of the site.

Your thoughts and comments are always welcome.
Best regards,

Ehab

Pre-op with failed RST attempt
Pre-op PA

Rotated palatal pedicle
Post removed and root reshaped


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15 Comments

Ehab, this looks great now. How was the root treated for RST?
Keep us posted on evolution of the case.

Regards.
Jorge


Reply

Hello Jorge,

All I did was remove the post by trephining around it, and I reduced & scalloped the root and osseous crest in order to get a nice pontic site.

Thanks for your comment my friend,

Ehab


Reply

very nice management....why do you feel the complication happened? Dr. S


Reply

Hi Ehab. Great case for discussion. It appears a vertical fracture associated with the post contributed to the failure. You managed quite well, but I suspect you may have not gone far enough to address the fracture and associated root contamination. Hopefully I am wrong. I look forward to the evolution. BTW I just booked my flight to San Diego. See you soon my friend:-). Chuck


Reply

Chuck,

Not sure about the fracture, but will keep monitoring for any changes that come up ( Hopefully not :) ).
I will know this week whether I will make it to San Diego. Hopefully I can, and we can get to spend some quality time with a few drinks this time :)

All the best my friend,
Ehab


Reply

Are you kinding? You are one the reasons I am going!!! BTW looking at the case again that is a CRAZY BEAUTIFUL SURGERY!!!


Reply

Thank you Dr Salama. I believe the failure here was due to 3 factors:

1-I did not reduce the root enough.
2-This was part of a crown lengthening case. I depended on tissue mobilization of a large flap to close over the root, rather than placing a CTG.
3-Perhaps incomplete removal of the post is also a factor.

Would love to get your take on this, since this is pretty much your baby :)

Best regards,
Ehab


Reply

Ehab,
Even a complication management could be beautiful! Perfectly!
I am also curious about a reason for failure. If not vertical fracture perhaps a superficial soft tissue infection, root not submerged enough...scenario like we see sometimes if healing abutment falls, but there is only superficial soft tissue inflammation without bone resorption?
Thank you far sharing, in this early PET age it is tremendous valuable post!
Best regards
Snjezana


Reply

Dear Snjezana,

Thank you for your kind words. It means a lot coming from you, especially that you are a master of rotated palatal pedicles :)
As for the cause, please see my response to Dr Salama. Probably the biggest factor is not adding a CTG, what are your thoughts?

Warm regards,
Ehab


Reply

Ehab, I cover regularly vital roots with CTG. Non vital roots - depends on aesthetic demand, but mostly I just submerge them and place a fixed provisional. I think that root covering is not necessary to submerge a non vital roots.
And your PCTG is a poetry:)
Best regards
Snjezana


Reply

Beautiful as always :)

Ehab,


Reply

Ehab.
Interesting case you show here. I believe too that root prepare is an issue for "guided healing".
On this case just a thought to share with you: the fracture needs to be removed promoting a bleeding:; if that doesn't happens area may not heal, initially, with no soft tissue coverage or with inner Chronicles more apical infection if a thick graft is placed on top.
The solution key is endodontic not perio.
Great to see follow up of the case.
Best regards.
Armando
Ps.: We miss you in NY:)


Reply

Hello Armando,

Thank you for your comment my friend. I wish I could've joined in NY too, it sounded like a great meeting. Will follow up the case and see how it progresses, will keep you posted.

Warm regards my friend,

Ehab


Reply

Ehab,,

Great post - clean Photography. Being that you are all the champions of RST & PET - Do you have a study of the likelihood of of root fracture associated with post treated teeth for RST Or PET - could we look at some of the pet related failures maybe because of microfractures or created during post removal ?

So ... Was implant placement not a consideration ?

Cheers,

Richard


Reply

Dear Richard,

Thank you for your comment. This patient is getting crowns on all his anterior teeth, that is why we opted for a bridge solution rather than an implant. I am unaware of such study, perhaps our endodontic colleagues can help?
Several issues we have to explore with PET. However I believe that this forum will be the place to get all the answers we are looking for :)

Best regards and hope to see you soon my friend :)

Ehab


Reply


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