"Never judge a book by its cover," but we always do dont we?
Hello friends. #30 appeared to be unrestorable and the patient adamantly declined an implant.
Can "Herodontia" be used for treatment plan "phasing?"
We took a cbct scan to evaluate whether we could even keep the RCT in house and did not refer.
After a review of symptoms and pulp vitality testing we began the procedure and here is what we saw after we removed the PFM crown.
After gross decay removal we were all shocked the nerve was not exposed or even blushing.
Because Zirconia is so biocompatible with soft and hard oral tissues; we can place the crown quite subgingivally with great success.
Of course, the very guarded prognosis was reinforced again at the end of the appointment and the patient stated,
"Well, when this fails I want an implant"
The moral of the story is; "Herodontia" can be part of "Treatment Plan Phasing" that allows the patient to become more comfortable with previously refuted options. He was not mentally prepared to go from a crown straight to an implant. Despite my most thorough advisement; his previous dental knowledge, exposure and experience required him a stepping stone to the implant psychologically.
Great save, even if you only get a little more life out of it and the patient was game. I don't think I would have been brave enough to try that, those roots are positioned nicely for an immediate implant :)
Nice job. I do “herodontia” every day in old Burlington N.C. It’s just the way it is in our area.
Great job, Jake, but I would consider it a provisional. Dan is right--great case for an immediate!
Looks really nice, was any bone recontouring needed?
I had one like this that had deep root resorption. I placed emax as I don't have chairside zirc.
On 1/23/2019 at 5:49 pm, Gordon Lewis said...No sir, it was not needed. I suspect the bacterial infiltration and decay process was at such a slow pace that the nerve tissue and bone tissue both retracted and remodeled in such a lucky way explaining why she had zero symptoms and we were able to "provisionalize" or "phase" the tooth with a zirconia crown only. We were fully prepared to treat the nerve and bone and the patient was ready to pay for any and all treatment; however after full re-evaluation including a new CBCT scan post decay removal, we did not believe it to be necessary.Looks really nice, was any bone recontouring needed?
I had one like this that had deep root resorption. I placed emax as I don't have chairside zirc.
Been practicing for 34 years. This type of compromised treatment will tend to come back and bite you. In my state there is no ability for the patient to agree to substandard care.Sorry to be blunt , I would hope that you called this pallative or temporary. Somepatients just need to be told no.
On 1/24/2019 at 8:44 am, Robert Bunn said...Been practicing for 34 years. This type of compromised treatment will tend to come back and bite you. In my state there is no ability for the patient to agree to substandard care.Sorry to be blunt , I would hope that you called this pallative or temporary. Somepatients just need to be told no.
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Secondly, this is absolutely temporary. It is a "provisional" or just the beginning "phase" of his treatment plan. The final restoration will be an implant, abutment and crown. This is in no way shape or form, substandard care and provisional treatment does not have a big bite.
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On 1/24/2019 at 8:44 am, Robert Bunn said...Been practicing for 34 years. This type of compromised treatment will tend to come back and bite you. In my state there is no ability for the patient to agree to substandard care.Sorry to be blunt , I would hope that you called this pallative or temporary. Somepatients just need to be told no.
I think we've all been in Jake's shoes and I for one think he handled it well. Discussing treatment plans, going over risks, removing all the decay, evaluating the pulpal health and placing a (hopefully) long-term provisional restoration is not substandard care in my opinion. This is beyond what I probably would have attempted, but I think Jake did a great job.
