implants UK - the journal of oral implantology

38 I I clinical _ sentimental tooth implants1_2011 _“Areyousureyoucannotdoanymoretosavethe tooth,Ireallycannotbeartoloseit,itwillbedevastat- ing for me, I am sure there is something that you can do, pleeease!” How often have we heard this from our pa- tients, only to make us pull on our imaginary dental pants/knickers over our dental work trousers, pull our mask over eyes and say: “YES! Super Dentist will save this tooth!”? As silly as this might sound, as time passes,weasthedentistfeelsillywehaveletourselves be taken down this road, only to find that one day ab- solutelynothingelseisleftinthetoolkit.Despitemuch ‘loving’ by both patient and dentist, the tooth cannot be saved. This is a classic case of the Sentimental Tooth treated with ‘herodontics’. The following cases illustrate this well. _Case 1 This patient first came to see me when she was 62 years of age. For several years she had suffered with pain on the right side of her face. She had suffered three trauma injuries over the years on the right side; the last involved being hit by a boom which served to worsen her condition. The patient had been seen by various specialists and her last maxillofacial treat- ment involved a combination of Tegretol (for severe pain) and occasional Amitriptyline. She found that fortnightly facial massages also helped to keep the pain under control. The patient had a generally well maintainedmouthwithevidenceoflocalisedareasof periodontal disease in particular around the UR4 and UR7. As the patient was keen to have implant retained teeth on the right side, she was sent for a CT scan. The OPG view of the scan (Fig. 1) showed severe bone loss around the UR7 and with a thickened lining of the right maxillary sinus. The 3D CT view indicated a perforation of the maxillary floor (Fig. 2) and hence a constant chronic infective state commu- nicating into the sinus which would be consistent with the thickened sinus lining. The patient was very reluctant to be lose the UR7 and advised me how her previous dentist and the periodontal specialist were trying to save this tooth, in fact not long before she saw me she had undergone further periodontal therapy on it. The case of the Sentimental tooth Author_ Dr James Main, BDS (Edin) MFGDP RCS (Eng) Fig. 1_:OPG Fig. 2_: CT 3D image of a perforation into maxillary sinus Fig. 1 Fig. 2