Crown Lengthening question - Laser Dentistry Forum

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June 2, 2004 at 7:47 pm #3276 Reply

drnewitt
Spectator

This lady came in to see me today with a request to recement a loose bridge. After removing decay from the #24 (#13) margins were thin and at the crestal level on the palatal.

The existing bridge has a history of coming off, which is not a surprise due to the mininal amount of coronal height.

I sealed off the 24 with temp for the moment as the patient is not available for tx until August.

I would like to get some opinions on tx options here. There is a lot of tissue bulked up around the molar and the previous dentist only preped to the height of the tissue. The first pic show the 1st and 2nd premolar. Its the 24 I am worried about. I am thinking that with laser crown lengthening (open flap) there will be enough crown height for retention but with the amount of decay on #24 there may not be enough strength to support a 3 unit bridge. #24 could be extracted and an implant placed.

June 2, 2004 at 9:04 pm #9745 Reply

michael sim
Spectator

Paul,
you may be better to extraxt #25(ul 2nd premolar) and place an implant (bone ht amd volume to be satisfied 1st ).
The RCT is poor , there is the probable endo lesion.and i do not like using a RCT treated single rooted th as a terminal abutment for a posterior bridge. The darn thing will break .
What do the seasoned wet finger dentistry operators think ?

michael

June 3, 2004 at 1:51 am #9742 Reply

drnewitt
Spectator

Thanks Michael

thats the way I was leaning with the patient but wanted to get an idea what the masses thought. The endo is asymptomatic but not something I would want to leave as is. I have seen teeth like this split under crowns before which is why I wanted to draw on others experience.

June 3, 2004 at 5:23 am #9749 Reply

ASI
Spectator

Hi Paul,

Many options but this is off the top of my head:

1. If keeping second premolar as a single crown, it needs endo retx/poss endo sx, flap approach osseous reduction for crown lengthening, post/pin & core. Fair at best predictability for success for such herodontics.
2. If not keeping it, best to extract and do immediate implant. Most predictable.
3. Definitely unpredictable even with herodontics to use 2nd premolar as abutment to new bridge.
4. Sinus lift with osseous graft tenting & wide body immediate implant at pontic site. Highly predictable for success.
5. New onlay/crown for 2nd molar is a safe bet.

What does the patient want? Sky’s the limit! By August, 2nd premolar may need extraction anyhow.

Good luck.

Andrew

June 3, 2004 at 4:52 pm #9746 Reply

Samuel Moss
Spectator

Hey,
Nice photos.

I know the angst you are going through. I agree with the previous poster: that premolar is at incredible risk NOT to be a long term survivor. Been there, tried the crown lenghtening on premolars. The endo is suspect, but any endo compromises wholeness and strenght. Your crown/roor ratio will doom this tooth. To use it as an abutment to a fixed bridge would be to invite future misery to both you and your patient. Say bye-bye to the premolar, place an implant(or 2) and sleep better at night.

My &#360.02, for what it’s worth.

Mossman

June 3, 2004 at 5:36 pm #9747 Reply

whitertth
Spectator

I agree as well…extract and place the implant …it is very predicatable…

June 3, 2004 at 8:43 pm #9750 Reply

Dan Melker
Spectator

I agree! Yes implant great idea. Just a thought-
1. first bi has an old amalgam
2. quarantee that if second bi retreated with a successful endo-post core buildup and surgery to create ferrule effect a bridge could be done double abutting bi’s to molar.
3. second bi appears radiographically to have type of root that would be very stable.
4. both adjacent teeth need new restorations. We are not cutting down sound tooth structure to do a bridge.
Long before implants there were bridges that lasted a long time. Again the implant is a great idea and I am simply voicing an option if the patient did not want an implant.
Danny(in my mind retreatment of root canal would be key)

(Edited by Dan Melker at 5:47 pm on June 3, 2004)

June 3, 2004 at 10:26 pm #9748 Reply

whitertth
Spectator

Danny,
The only issue I have with that is when teeth are so broken down, even with a good ferrule, they never seem to work out for long periods of time… Financially, and long term an implant is more predictable, so I dont even offer another option…Not knocking what u said at all, it is possible I just never like teeth like this one…

June 3, 2004 at 11:24 pm #9751 Reply

Dan Melker
Spectator

Ron,
I absolutely agree. Only thing is not everyone will go ahead with possible sinus lift and implant. What I was trying to do is get everyone to start to look at adjacent teeth. So many times we focus on the implant and forget the natural teeth.
Other thought is by doubling abutting not the concern we have as when we end a bridge on a endo treated tooth.
Ron, another thought is to extract 2nd bi and bridge bi to molar. These are options if implant is not accepted. Also lets not forget natural teeth adjacent to tooth in question.
I was more interested in getting a discussion than formulating a trt. plan though again I agree 100% with your recommendations.
Thanks,
Danny

June 4, 2004 at 5:59 am #9743 Reply

drnewitt
Spectator

The three abutment option is interesting. I really appreciate all the input and the discussion that opened up over this case. I know we spend a lot of time presenting cases we have completed on this forum but I wasn’t sure how presenting a pending case would go over.

Not sure if hardtissue was the category to place this under though. what do you think Ron? A new category for pending case presentations and how we could use lasers to aid in the treatment.

June 4, 2004 at 11:32 am #9741 Reply

Anonymous
Guest

QUOTE

Quote: from drnewitt on 1:59 am on June 4, 2004
A new category for pending case presentations and how we could use lasers to aid in the treatment.

Great idea!

June 4, 2004 at 9:19 pm #9744 Reply

drnewitt
Spectator

wow. speedy! Thanks Ron I get two more wishes…right??

February 7, 2015 at 8:08 am #9752 Reply

Boksa
Spectator

Thanks Paul i really appreciate your efforts for making things easier.

June 25, 2015 at 11:38 am #9753 Reply

ssfamilydentistry
Spectator

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