Hi etienne,

I assume #35 is the mandibular molar with all the bone loss on the distal root?

I wouldn’t hestitate in my efforts to keep #8.
#35 I would first pulp test, check occlusion and then discuss with the patient on whether or not they wish to proceed with IMO herodontics.

It appears that with proper tx and home care the overall prognosis would be good and #35 would be guarded if treated.

What type of perio treatment (wavelength/procedure) were you considering?

Anyone care to comment on Theileman’s Law?

Etienne,

You will need to fabricate a Michgan, Tanner or Panke splint–all the same name for a lower occlusal guard, in order to lock in #31.

You will ned to adjust the occlusion full mouth as this patient has occlusal disease that is involved on the LL as well as the LR (#31).

No worries on #8 and the level of bone loss–just your laser dosimetry.

Still care to give it a go?

Bob

You will need to spint #8 at the time of treatment with Ribbond and composite, ortho wire and composite

Etienne,

Thieleman’s Law = posterior malocclusion has reciprocal anterior (cross-arch) pathological manifestations. #31 occlusal interference = trauma to #9. The fact that #8 also has pathology means the lower left posterior is involved but is not obvious on the radiographs. Hence the need for a full lower occlusal guard.

This is a classic example.

#31 is probaly perio/endo and will want to super-erupt when you treat. Intracoronal splinting in these cases is not a good idea. A well secured Ribbond splint which is tucked into the buccal interproximal then layered over with a hybrid composite will much more likely stay secure.

Combine with a Tanner full lower splint should help to stablized the tooth and the occlusion.

Use the settings I emailed to you.

Dosemitry = no more than a minute on each large defect as I described. You can always treat again.

Good luck!

Bob

Great documentation Etienne….it sure helps alot when you post stuff like you have.

Well if 31 tests vital then you still have a chance to cold. I find ALOT of these teeth with MO amalgams in the 2nd molars on clenchers have distal cracks and these run very deep. The crack may exit like mine did on the lingual (very sensitive to cold and to chewing) or may go vertical on the distal. Were the probings in a wide area (ie was the whole distal surface wrapping around to the buccal and lingual involved) or was it a very narrow trough.

Narrow trough suggests vertical crack.

Just warning you to be on the lookout for this. THere is obviously ALOT of bruxism going on looking at all the abfraction lesions and I am not a big occlusion guy like Bob is. What great information about Thielmans law…..another thing I didnt know.

For splints, I am not the guru that Bob is. I typically use a thermoplastic splint that covers the occlusal surface of one arch. Bob is much better able to handle this question than me.

Finally, congrats on the scope. It will open your eyes to so many things, but be patient and if you have questions dont hestitate to email me if I can be of any help.

I forget now which brand you bought , but I can be of some help with positioning etc with all brands.

Thanks again for an intersting case, I learned quite a bit from Bob as I usually do.

Glenn

THanks for the kind remarks Etienne, it was a first attempt and something designed to help out people out there who didnt have anything to go by. Its amazing the places I have shipped them including USA , Israel, Japan, Europe (all over) and Africa just a few off the top of my head.

I hope it helps but dont be afraid to bug me if you need help and I for one admire what you are doing with lasers and scopes to help your patient. You should be darn proud of what you are attempting to do.

Kudos to you and do keep me informed. Its a neat case.

Glenn