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roots - international magazine of endodontology No. 3, 2016

| CE article treatment planning 12 roots 3 2016 Case report Thiscasereportdemonstratesanalternativetreat- ment option for a patient to save their natural tooth. A 70-year-old female presented to an endodontist’s office with a complaint of persistent pain to biting. Tooth #31 had a history of root canal treatment and coronalrestoration.Athoroughexamination,includ- ing CBCT, led to the diagnosis of previously treated tooth #31 with symptomatic apical periodontitis. A detailed explanation of the risks and benefits as- sociatedwithalltreatmentoptionswaspresented.The patientexpressedastrongdesiretosavehertoothand consented to intentional replantation. Tooth #31 was atraumatically extracted and continuously hydrated withHanks’BalancedSaltSolution.Nocracksorfrac- tureswerevisible.Apicalmicrosurgerywasperformed extraorally. The root end was resected, ultrasonically prepared and filled with mineral trioxide aggregate. The tooth was replanted. The patient remains asymp- tomatic and very satisfied with her treatment. A recent systematic review and meta-analysis re- vealed a mean survival rate of 88 percent for inten- tional replantation.* With careful case selection, in- tentional replantation may allow for a reasonable, cost-effective treatment option for teeth that do not 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. Helping patients maintain their “Teeth for a Lifetime” is the fundamental goal of dentistry and often aligns with the desires of the patient. A wide range of end- odontic 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, excellent endodontic treatment followed by animmediaterestorationofequalqualitypromisesto give patients service and function while maintaining their esthetics for years. The results of multiple stud- iesindicatethatthehighsurvivalratesforthenatural tooth are similar to those reported for the restored single-tooth implant. Therefore, clinicians must consider additional fac- torswhenmakingtreatmentplanningdecisions,allof whichmustbeinthebestinterestofthepatient.End- odontictreatmentandimplanttherapyshouldnotbe viewed as competing alternatives, rather as comple- mentary treatment options for the appropriate pa- tient situation._ EditorialNote:ThisarticleoriginallyappearedinENDODON- TICS:ColleaguesforExcellence,Spring2015.Reprintedwith permissionfromtheAmericanAssociationofEndodontists, ©2015.TheAAEclinicalnewslettertogetherwithacomplete listofreferencesareavailableatwww.aae.org/colleagues. CasereportcontributedbyDrRobertS.Roda. * Torabinejad M et al. Survival of intentionally replanted teeth and implant-supported single crowns: a systematic review.JEndod2015(inpress). about Dr Scott Doyle was raised in Eau Claire,Wis.He received his BS from the University ofWisconsin-Madison in 1995 and his DDS from the University of Minnesota in 1999.After graduation from dental school,Doyle served in the United StatesAir Force for seven years. His first assignment was at EglinAir Force Base,Florida,where he completed an advanced education in general dentistry residency. He practiced as a general dentist for two years atAltusAir Force Base,Oklahoma,prior to his acceptance into an endodontic residency.Doyle obtained both his MS and certificate in endodontics from the University of Minnesota in 2004.He is a diplomate of theAmerican Board of Endodontics,attaining board certification in 2011.He currently serves as an associate clinical professor for the Division of Endodontics at the University of Minnesota.He is a member of the American DentalAssociation,the Minnesota DentalAssociation,the MinnesotaAssociation of Endodontists and theAmericanAssociation of Endodontists,as well as a variety of study clubs. He is currently president of the MinnesotaAssociation of Endodontists. Fig.9: Post-op image. Fig.10: Seven-month recall image. Fig.9 Fig.10 32016

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