By: Victor M. Sternberg, D.M.D.
August 9, 2023
An interesting case study of a patient of mine for many years. The gentleman, age 80, had been under care for periodontal maintenance for 35 years. He had all virgin teeth with no caries or restorations. At the age of 80 he developed root caries just below the CEJ of tooth #3.
At that point he had been periodontal stable all those years and this was the first carious lesion he had ever developed.
What would be your treatment plan for this gentleman? I'd like your feedback because I want to share with you what happened.
The dentist elected to make a full crown on tooth #3 for the small root caries that was evident. Subsequently when the tooth became painful the dentist performed endodontic therapy. A post was placed in the mesial buccal root and currently the patient has a large periapical area and discomfort upon biting. As you can note, the endodontics was not done on the mesial buccal root.
Now the choices are really complicated. After spending a great deal of money it is possible that this tooth cannot be retreated given the post in the mesial buccal root. Resecting the mesial buccal root is a choice as is extraction or redoing the root canal.
If neither of those alternatives are viable, the loss of the tooth is possible.
Given the sequence of events and the outcome, I think it is valuable to share this with my colleagues and as always, welcome your feedback.
Victor M. Sternberg, D.M.D.
By Westchester Center for Periodontal & Implant Excellence
August 10, 2023