Pocketing Between #2 And #3

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Nick,

Notice the radiogaphic evidence of bone loss between #2 and #3. I still treat all teeth the same. Thanks!
Is there an advantage to having a perfect root surface to place a margin? Is there an advantage to have a surface that is flat, devoid of irregularities that allows for better maintenance? I think we need to consider why plaque and calculus are present and try to change the environment so preventing their return is easier

Danny

[text document redacted?]
[photographs redacted?]

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Danny,

Again, what do you do with deep class II furcation involvement, class
III furcas, mobility I+ or II? what about leaving a negative crown to
root ratio? I guess i’m just wondering your criteria for removing and
going another direction?

Nick

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by the way, another great case!

Danny

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Danny,

Again, what do you do with deep class II furcation involvement, class III furcas, mobility I+ or II? what about leaving a negative crown to root ratio? I guess i’m just wondering your criteria for removing and going another direction? ClI furcations I believe I can usually treat with Biologic shaping. ClII’s are simple. All based on adjacent teeth and the tooth in question, restorative needs. I know some would say extract and preserve bone for an implant. If the tooth in question has no defects but a CLIII which we see and no restorative needs I would do a tunneling procedure.
If restorative or defects effecting adjacent teeth EXTRACT and implant or bridge again based on adjacent teeth. Mobility really does not bother me in my decisions to keep teeth unless extremely loose. The greatest concern for me is decay and adjacent teeth effects if crown lengthening needs to be done. I consider implants over destroying bone on adjacent teeth. Interestingly, to me crown lengthening is the hardest procedure I do. Periodontal disease
kinda has already taken care of the bone and all I have to do is get the teeth ready for restorative again assuming restorative is necessary. Hope this helps but typing does tend to leave out a lot of meaning in my case as I suck at typing and thinking at the same time.

Thanks Nick for your interest,

Danny

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My concern is that you’re now leaving a larger food trap in a patient who has shown (or whose restorative dentist and hygienist have shown) an inability to maintain a clean surface. Yes, flat will be better, but there may be more chance of recurrent decay or future periodontitis.

Bob

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Having done this procedure for 36 years and for 20 with bonding neither of your concerns have ever surfaced. Frankly recurrent decay is probably less than 5% if that high and inability for maintenance is about the same. My practice is 90% perio-restorative so the majority of the teeth I treat have old restorations and will need retreatment. The case shown is probably 10 years plus. Bob I could bore you with case after case of exactly the same treatment but hopefully you will take my word that the success rate of these types of cases run at least 95% and I expect 20 year plus frame. I can not change porcelain fractures but as far as your concerns they simply don’t come to pass. BTW my referrals pretty much document their failures and in particular Dr. Bill Strupp and he virtually never ever sees decay as a cause for failure.

Have a great day,

Danny

As a side light to me once I have removed the CEJ(Artice by Dr. Charley Cobb and John Rapley exposed the problems with Biofilm and CEJ’s, irregular root surfaces and so on maintenance by the patient and hygienist improves dramatically. Thus the success rate again dramatically improves.

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Thanks, Danny.

Please, if you have it, send the reference for the article.

Bob

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Thanks Danny!

I guess for me, try as I may, most patients that do get
referred to me seem to be in the severe, failing stages. for years
I’ve tried to convince that the best time to send patients to “save”
teeth is when they are mildly/moderately involved. I think day after
day of seeing these severe patients who are the way they are for a
reason, makes it hard on me mentally because I’m left to try and save
teeth that really are past their due. I think you’re right that it
really comes down to the education process……..
If only money weren’t a concern!

Nick

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http://cde.dentalaegis.com/courses/4499

Bob,

Above is the article that makes it part of common sense to remove CEJ’s for long term maintenance of teeth when possible.

Thanks,

Danny

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Danny,

Is this the reference you are citing..? It is an expansive literature review
Non-Surgical Pocket Therapy: Mechanical,
Charles M. Cobb

Annals of Periodontology November 1996, Vol. 1, No. 1: 443-490

I could not copy and paste the article but if you go to page 472/473 it says more recent articles challenge the validity of aggressive cementum removal. It is a very interesting article..I still have not finished it.

Dominic

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Thanks Dominic but I posted the article site on an e-mail. The article is from the Compendium this year.

Danny

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Thanks, Dom and Danny.

Bob

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I fully understand where you are coming from. Why so many GP’s think
we are now the last ditch effort for keeping teeth is beyond me.
Maybe and don’t anyone get mad at me but we have set up ourselves
more of implantologists than keepers of natural teeth. When I
present many times a Restorative Dentist will say do you know a
Periodontist that wants to keep teeth? Sorry for my statements if
they offend anyone. My feelings about teeth go back to Henry
Goldman, Gerry Isenberg in the early 70’s. On a Sunday we would sit
in Dr. Isenberg’s basement and look at 25 year old cases of Dr.
Goldman. Weird how they were able to keep teeth in those days??????

Danny

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