To save or not to save?

78 Rating(s).


Posted on By Ehab Moussa In Periodontics

Patient presents with large and deep carious lesion on #3. Decision was to perform RCT and a crown lengthening procedure with biologic shaping. This is one of my favorite procedures to perform but I would be interested to know the thoughts of other group members on how to manage this case?

Best regards,
Ehab




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11 Comments

Ehab. I totally agree! Save ala Danny Melker. I look forwardto seeing your outcome. Best wishes. Chuck


Reply

Thank you dear Chuck. I was fortunate to have Dr Paul Ricchetti as my mentor through residency and he shares the same tx concepts with Dr Melker. I posted the rest of the case :)

Ehab


Reply

Sorry everyone, been having trouble posting the rest of the photos.

Pre-osseous palatal


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Post-osseous sx and biologic shaping.


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Healing at 6 weeks.


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Beautiful work. I was lucky enough to be invited to attend Danny Melker's seminar on Biological Shaping as a third year resident. He changed the way I look at crown lengthening. Dr Richetti has also influenced my treatment around furcations. Great work and awesome results. If I were to be critical, I would recommend a graft to widen the band of attached keratinized tissue on the buccal furcation for long-term stability. This can also be done during the biological shaping surgery with a connective tissue graft sutured to the periosteum as Melker does. Great work !!!


Reply

Naheed,
Thank you for the kind words and no argument there, most cases will look better with the addition of a CTG :)
I was fortunate enough that Dr Ricchetti started coming to teach us twice a week when I was in my second year of residency. I have to say that he completely changed my take on SAVING TEETH, tx planning, and osseous surgery.

Thank you for your comment and I do hope that we can meet soon my friend.
Ehab


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Ehab, congratulations. Great skill and service to your patient. Do you always contour the bone inter proximally and palatally during your osseous surgery? what instrument do you recommend to reach that difficult area in posteriors. Thanks, Ashok.


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Dear Ashok,

Thank you for your words. IMHO, the most important factor in this surgery is OSSEOUS sx, with other factors like odontoplasty, flap thickness, and positioning following that. For osseous sx I simply rely on round diamonds and an end cutting bur to contour. I will sometimes also use a Wedelstaedt chisel to remove any bony peaks that remain. Following that I perform the odontoplasty.
Always a pleasure to hear from you,
Ehab


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Ehab, perfect work and no question....SAVE is the Way! Dr. Salama


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Dr Salama,

Thank you so much !!
Your comments are always a source of motivation.

Best regards,
Ehab


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Versah
KLS Martin