A dental colleague sought advice on how to approach a problem involving teeth #14 and #15 where there was interproximal caries on both. As you can see in the image below, the root proximity of the two teeth precluded an effective restoration. 

The distal buccal root of #14 and the mesial root of #15 are literally in direct contact. Endodontics had been done and there was no evidence of periapical pathology.

The patient understood the challenge of preserving #15. However, given the desire to retain #15 he elected to think outside the box. 

The severe curvature of the mesial buccal root of #15 made its complete removal nearly impossible without removing almost the entire buccal plate. Even then it would be challenging and most likely it would end of with the loss of #15. 

The decision was made to partially remove the mesial buccal root to a point where it would no longer be in contact with #14, and bone graft over the remaining stump of the mesial buccal root. 

The roots were so close together that a scalpel had to be used repeatedly, after the root was reduced in height, to separate the fragment of the mesial buccal root of #15 from the distal of #14.

Beginning to cut down the root. 

Following segment of the root removed adjacent to #14. 

The area restored and healed. The root segment was covered by bone following a graft. The restoration has an atypical contour due to the removal of the mesial buccal portion of the tooth, but the embrasure is open. 

This is certainly an out of the box approach for a patient who is in our profession and was willing to undergo this rather unorthodox approach to treating an intractable problem. Ideal it is not. But a 75-year-old colleague was pleased he could keep #15. 

As always, I appreciate your feedback. 

Yours truly, 

Victor M. Sternberg, D.M.D. 

By Westchester Center for Periodontal & Implant Excellence

December 31, 2023