roots C.E. - the international magazine of endodontology

I 11 roots 1_2016 C.E. article_ treatment planning I has experience with various treatment options that have potential to preserve the natural dentition. Consultation regarding a questionable tooth is often in the patient’s best interest prior to consid- ering extraction. If the prognosis of a restorable tooth is categorized as questionable or unfavorable in multiple areas of evaluation, extraction should be considered after appropriate consultation with all relevant specialists. Only then is the decision to extract an informed choice. Extraction is an irre- versibletreatment,butifnecessary,dentalimplants provideanexcellentoptiontoreplacemissingteeth (Figs. 6a, b). _Case report A case report (Figs. 7-10) demonstrates an al- ternative treatment option for a patient to save a natural tooth. A 70-year-old female presented to an endodontist’s office with a complaint of persist- ent pain to biting. Tooth #31 had a history of root canaltreatmentandcoronalrestoration.Athorough examination, including CBCT, led to the diagnosis of previously treated tooth #31 with symptomatic api- cal periodontitis. A detailed explanation of the risks and benefits associatedwithalltreatmentoptionswaspresented. The patient expressed a strong desire to save her tooth and consented to intentional replantation. Tooth #31 was atraumatically extracted and contin- uously hydrated with Hanks’ Balanced Salt Solution. No cracks or fractures were visible. Apical microsur- gery was performed extraorally. The root end was resected, ultrasonically prepared and filled with mineral trioxide aggregate. The tooth was replanted. Thepatientremainsasymptomaticandverysatisfied with her treatment. A recent systematic review and meta-analysis revealed a mean survival rate of 88 percent for in- tentional replantation.* With careful case selection, intentional replantation may allow for a reasonable, cost-effectivetreatmentoptionforteeththatdonot heal following endodontic treatment. Clinicians are advised to explore all options before recommending extraction. Referral to an endodontist can aid in the retention of a compromised tooth. _Conclusion Patients are living longer; therefore, preservation of the natural dentition is more important than ever. Helpingpatientsmaintaintheir“TeethforaLifetime” isthefundamentalgoalofdentistryandoftenaligns withthedesiresofthepatient.Awiderangeofendo- dontic procedures result in a high level of tooth re- tention and patient satisfaction. Large-scale studies provide strong support that the restored endodonti- cally treated tooth offers a highly predictable, long- term approach to preserving “nature’s implant” — a tooth with an intact periodontal ligament. Thus,excellentendodontictreatmentfollowedby an immediate restoration of equal quality promises togivepatientsserviceandfunctionwhilemaintain- ing their esthetics for years. The results of multiple studies indicate that the high survival rates for the natural tooth are similar to those reported for the restored single-tooth implant. Therefore,cliniciansmustconsideradditionalfac- tors when making treatment planning decisions, all of which must be in the best interest of the patient. Endodontic treatment and implant therapy should not be viewed as competing alternatives, rather as complementary treatment options for the appropri- ate patient situation._ ThisarticleoriginallyappearedinENDODONTICS: Colleagues for Excellence, Spring 2015. Reprinted with permission from the American Association of Endodontists, ©2015. The AAE clinical newsletter is availableatwww.aae.org/colleagues. A complete list of references is available from the publisher,andalsoatwww.aae.org/colleagues. CasereportcontributedbyDr.RobertS.Roda. *Torabinejad M et al. Survival of intentionally replanted teeth and implant-supported single crowns: a systematic review. J Endod 2015;41:992-998. Scott L. Doyle, DDS, MS, received his BS from the University of Wisconsin- Madison in 1995 and his DDS from the University of Minnesota in 1999. He servedintheUnitedStatesAir Forceforsevenyears,includ- inganadvancededucationin general dentistry residency. Doyle obtained both his MS and Certificate in Endodon- tics from the University of Minnesota in 2004. He currently practices with Metropolitan Endodontics in Minneapolis and servesasanassociateclinicalprofessorfortheDivisionofEn- dodonticsattheUniversityofMinnesota.Doyleisadiplomate oftheAmericanBoardofEndodontics.Heisapastpresidentof the Minnesota Association of Endodontists, chair of the AAE ContinuingEducationCommitteeandservesasareviewerfor theJournalofEndodontics.Doylehaswritten multiplearticles in scientific journals, as well as a chapter on the “Endodontic ApplicationsofCBCT”inanupcomingtextbook. _about the author roots

roots C.E. - the international magazine of endodontology

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