Friday, June 22, 2007

Time for an Implant

This patient was referred to my office today to finish the RCT on #5. I was obviously a little concerned about the restorability of the tooth. Since she traveled quite far, and her referring dentist had sent her, I went ahead and opened it up to take a peek.

This is what I found. (not surprising)

We discussed the options:


1. RCT $800

2. Build-up $250

3. Crown Lengthening $700

4. Crown $800

Total $2550 with guarded/poor prognosis


1. Extract $200

2. Implant $1800

3. Crown $1000

TOTAL $3000 with excellent prognosis


1. Extract $200

2. Bridge $2400

TOTAL $2600 with excellent prognosis

It is obvious that an implant or bridge will have a better long term prognosis than trying to save this tooth with endodontic therapy, perio therapy & restorative therapy. This is a situation where I made a recommendation for extraction. Since #4 has a nice crown and #6 is a virgin tooth, if it were me, I would personally go with the implant option.

In my practice, I always try to give my patients the same treatment that I would want for myself or my family. I think we owe it to our patients to give them all of the options.

1 comment:

Anonymous said...

Dr. Hales,

I know this is an old post, but I am facing a similar situation myself.

I'm 22, and I had an issue with tooth #30 around the age of 15. My general dentist advised me to extract it, while a second opinion recommended endodontic treatment. I had the root canal done, and a crown put on.

Now a recent x-ray has revealed a new infection at the bottom of one of the roots. My general dentist (a new one) recommends retreatment, a crown lengthening, and a new crown. However, when an endodontist took a look at my x-ray, he saw a dark area under the crown that he said indicated bone loss. The general dentist doesn't agree, but both say that nothing will be known for sure until the tooth is opened up.

I'm not against retreatment, but with potential bone loss at what point do you typically advise extraction?