(Mouse-Over the xrays to help reduce your confusion)

There’s determination to keep your teeth, and then there’s determination.

I saw this patient back in 2004 for consultation about these front teeth. The original work was done in China not too long before. I suggested that she consider replacing the teeth, but she was determined to hold onto them. Apical surgery wasn’t a great option because of the depth and size of the posts and shortness of the roots. Deficient crown margins with resulting coronal leakage also substantially reduced the prognosis of anything I could do.

Reluctantly I started with a retreatment of 21 and aborted the procedure once I saw multiple perforations resulting from the post placement in the apical area of the root (pretty much an expected result after looking at the preop film). I told her to forget having me do any work on the 21 and the 11. The 12 and 22 maybe. I’d need to do an internal perf repair on the 12.

I lost track of the patient soon after because she ran out of insurance for that year. We got a call from her husband the year after to let us know that she was going back to China to see if they could do anything there (it would be cheaper).

When I saw her yesterday (for a parulis associated with 12), she indicated that she had seen three “specialists” in China who told her to take the teeth out. She eventually found someone who did this work: looks like some retreatments, new posts and crowns, and apical surgery. She’s now got a scalloped submarginal scar across her front gums, but is otherwise pain-free.

So far, besides the 12, the teeth seem to be doing ok. I’ve told her to consider implant replacement of 12, and the same with each of the others as they start to fail (which may not be for a while). A bridge in the area is not a great option if any of these teeth are used as abutments.

So I’m trying to figure out what the moral of this story is. I’m sure there’s one.