Hi Ron,

Do you REALLY want to know what I would do??:biggrin:

Seriously, what does the patient want to do?  What does he want to invest in time and treatment effort and cost?

My orientation would be to try and save each and every tooth by doing endo, LANAP perio, occlusal adjustment, splint therapy and then seeing how he heals…….for the next 2 years!  Yes, even the lateral and #14. Touch up as required any perio pockets that partially heal.

But I think you’ll need a variable pulsed Nd:YAG for those deep pockets and considering his diabetic tissues! :cheesy:   Much better control over tissue response of the variety of tissue challenges in variable pocket depth and disease overlap.

I wouldn’t subject him to any more ortho though.

Bob

Ron,

Excellent case presentation and initial results. Based on the history, I would fully expect regeneration/new attachment.

Remember, “The depth of the bone defect is directly proportional to the amount of occlusal trauma”.

and, “If there is a bone defect, there is a traumatic force that directly correlates to that defect–and it is proportional to the amount and severity of the defect–so the clinican must find the trauma as it is often masked by mobility.”

The use of the Tek Scan is an excellent way to find the hidden trauma! Since I updated my software from 2.0 to 4.0, I am using it much more these days.

Great stuff Ron!

Bob

Bob , how did you go about finding the hidden trauma before you got your hands on the Tek Scan? Did you do full cast articulation?

bob,

I had one case today and 2 other cases in the last 4 months with furcal bone loss that had nothing to do with trauma. When you say every time do you allow for exceptions?

You see, these cases were sporting cemento-enamel projections. They were the only areas in the jaw with periodontal disease.

I think occlusion can be important, but it isn’t in play every single time. Would you agree given the examples I stated?

The reason I ask is I sat through a Bill Dickerson lecture. The highlights included him attributing 80% of endo to malocclusion/trauma and stating that 100% of exostoses and tori are related to occlusion. The latter statement is not reflected in the lit. It seems that some people are predisposed to bone formation genetically be it from normal or abnormal forces. Bone can either do nothing, resorb, or increase formation as a general rule. Some of these people will get exostoses in the presence or absence of occlusal trauma or malocclusion or whatever he was saying. In short, for a guy that likes to be on the edge, get in your face a bit, and criticize CR from a scientific standpoint, he somehow expects you to swallow it all without question.

And you’re no Bill Dickerson Senator…I hope

bob, didya get my email Re:October?

I’ll need some travel info.

Thanks for the review. Occlusion seems to shift in and out of focus every 15 or 20 years….one thing is for certain with GTR, it’s harder to grow it around a moving target, adjusting the occlusion is one way to address it.

I love the old school wax by the way.

Can you post a pic or describe what appliance you use as I thought you discussed a splint of some kind?