Case 1
“Patience is a Virtue”
Daniel Reich, DMD
[email protected]
38 yr old male (JS) who enjoys good health was referred for evaluation of tooth #31. He presented on 1/26/2012 for evaluation. Tooth #31 had a crown fabricated about 10 months prior. Tooth #31 has mild to moderate mobility and advanced probing depths (>10mm) into the buccal furcation. PA radiograph shows advanced bone loss into furcation area. Patient was advised that prognosis was poor and that tooth #31 should be extracted and the site grafted for future implant placement. He was hesitant to have any treatment out of concern for finances. He requested an insurance predetermination prior to treatment.
Patient called on 2/26/2012 complaining of swelling and pain on tooth #31. He was appointed on 2/27/2012 for Laser Periodontal Therapy as he refused to have extraction and was willing to treat even with a poor prognosis. JS was seen on 3/6/2012 for a one week evaluation and stated that his mouth feels comfortable and that he no longer has pain. He also stated that he feels that there is some “separation of his gum.” His occlusion was checked and adjusted. On 3/13/2012 JS stated that his mouth feels slightly better. Tooth #31 exhibited less mobility and an occlusal adjustment was performed. JS was seen again for a 6 week PO on 4/10/2012 and then again at 8 weeks on 4/23/2012. A PA radiograph was taken.
This 8 week PA shows an increase in lucency at the apex of tooth #31. His next appointment was scheduled for 4 months post treatment.
06/19/2012 – 4 months
JS stated that his mouth was comfortable. The PA radiograph shows increased bone density into the buccal furcation. Tooth #31 was mildly depressible. The occlusion was checked and adjusted.
Patient still asymptomatic. PA #31 shows increased bone density in the furcation area.
11/15/2012 – 8 month PO
Tooth #31 was not mobile but had residual advanced probing depth into furcation area. Patient was scheduled for additional Laser Therapy on 11/30/2012 to induce further regeneration.
12/27/2012 – One Month Post – Retreatment
JS stated that his mouth is comfortable. There was mild mobility.
2/7/2013 – 10 weeks Post Retreatment
Patient presented complaining of swelling of #31. I advised patient that prognosis of #31 was poor and recommended extraction and grafting for future implant placement. Patient refused extraction and was given an Rx for antibiotics. He was appointed for an observation 3 weeks later.
02/28/2013 – 13 weeks Post Retreatment
Patient presented stating that he feels much better and lost his Rx and did not take antibiotics. There was a 5mm probing depth into the buccal furcation. A PA radiograph showed additional increase in bone density. JS was referred to an endodontist to determine vitality and for a CBCT and was scheduled for observation on 6/6/2013.
06/06/2013 – 6 months Post Retreatment
JS stated that he is asymptomatic but did not have an endodontic evaluation or CBCT. PA radiograph appears similar to previous radiograph.
11/12/2013 – 11 months Post Retreatment
JS stated that he had a “flare-up” last week but was now comfortable. There was advanced probing into the buccal furcation with mild suppuration. He still did not schedule his endodontic evaluation.
11/21/2013 – Endodontic Evaluation + CBCT
Patient was seen for endodontic evaluation with a CBCT. The following report from the endodontist stated:
“The scan showed extensive furcal bone loss and the tooth did not respond to cold tests at this time. Even though there was an endodontic component to the bone loss, the furcal probing depths and extent and location of bone loss predicated a guarded prognosis for regeneration.”
JS did not schedule an appointment for almost 8 months after his endodontic evaluation.
Patient presented stating that his mouth was comfortable and was interested in having a different, edentulous site treated with a dental implant. A PA radiograph of tooth #31 showed significant bone fill into the buccal furcation. There was no mobility and the probing depth was only 3 mm into the buccal furcation. I advised JS that tooth #31 will likely require endodontic therapy and should be closely monitored. JS stated that he wants to proceed with an implant at the edentulous site on the opposite side of his mouth. He will be calling to schedule an appointment in the very near future.