Would You Refuse to Retreat This?
Retreatment July 3rd, 2008
Written on the referral slip that arrived with this patient was a note from their dentist, “Please perform apical surgery.”
I suppose the dentist was concerned about the post being irretrievable. My concerns were the probable coronal leakage that was causing the apical lesion and the fact that apical resection of the root would put me up against the end of the post — leaving me in a difficult position for a retrofilling. Apical surgery will not hold up against coronal leakage in a predictable fashion.
Assuming that the dentist could do a crown with a decent coronal seal, why not take the post out and retreat the root canal work? Retreatment would offer a more predictable solution for the tooth.
Ah, but a deep screw post like this is quite daunting to remove. We worry about the risk of fracturing or perforating the root.
Here’s what your average neighborhood endodontist should be able to do for you:
Microscopes, ultrasonic instruments, and training allow us to deal with cases like this in a conservative, predictable fashion. Orthograde retreatment of cases like these are viable options and should be presented to patients. Jumping straight to the surgical option is a disservice to your patient.
Update (August 14th, 2008): Here’s the post-op film:
July 4th, 2008 at 7:49 am
hmm….crown to root ratio looks questionable here, but again this is a periapical film. is there any mobility? how are the probing depths?
re-treatment would most def be the first endodontic option, esp because the original RCT is not ideal to begin with. my main concern is now the patient is spending money on a retreat, post (which i would do cast at this point, esp given the further weakening of the tooth from the retreat) and crown, possible crown lengthening. at this point, is it worth it to save the tooth versus extraction and implant? i didn’t see the tooth clinically so i don’t know. what do you think? have you ever refused to treat a tooth if the restorable prognosis is questionable?
July 5th, 2008 at 12:40 am
huh? didn’t understand a thing! lol! i guess the dental work must have been quite s job. my parents were both dentist but i became an architect instead. i’ve a daugther who’s about to finish her residency in pedodontics though.
btw, i like your landscaping.
desperateblogger’s last blog post..CAP Crappola!
July 8th, 2008 at 6:50 pm
desperateblogger: Your daughter will know all about what I’m talking about then
I see some similarities between architecture and dentistry though…
person: The long-term prognosis of this tooth is guarded because of the restorative issues. I discussed this extensively at the consultation. Since I’m not the restoring dentist, however, I make my concerns known verbally to the patient, and then in writing to the dentist. If they feel that they can achieve a stable restoration, I can’t argue with them.