Pt complaint of pain in the right lower back tooth region since a month ... Presented with normal mouth opening. Infer the IOPA & Chart out treatment modalities !!

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Dear doctors ... It's very fruitful to see each one coming up with alternative treatment plans for a single entity. But the problem of losing biologic width distal to 47 & Pocket formation distal to 47 lies at the hands of surgeon accepting that 8 should be removed invariably before completing rct +crown , when a 7 is indicated for rct and crown . Since removal at later time will result is inadvertent breakage of 7. Stil one more technique to preserve the biologic width or prevent distal pocket is not highlighted . I'll reveal after few more discussions . Thank you all .
@dr sriram. i think it again depends on the surgeons hand not to result in inadvertent breakage of 47 by tooth sectioning and putting no pressure on 47
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The other alternate treatment method which could be employed , in above situations is CORONECTOMY - involves removal of crown portion extending 1mm beyond CEJ., This technique was described in literature as early as 1980's.. But has found more acceptability only in 2000's.. Cannot be performed in cases with 1)third molar DC 2)periapical pathology 3)horizontally impacted Can be indicated in 1) close proximity to IAN 2) roots deflecting or encircling IAN 3) as indicated in our above case (caries to adjacent but not the impacted teeth ) Thank you all... !!!
thanks. went through the article
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one clinical tip for auto transplant. do 3d printing of third molar use it to prepare 2nd molar socket for reception of 3rd molar this way vitality of 3rd molar pdl is preserved and repeated tryinn and pdl injury scrape is avoided hence lesser chance of resorption and ankylosis. in the other hand sterelitho model of mandible help to do the mock osteotomy surgery .
Wah reh wah !! Dr.Joe - some of us could well be stealing ur ideas .,, it may become a poster,, paper or a thesis soon !! Good ideas. Keep sharing . We love it .
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We all agree that 48 needs to be extracted. Although RCT is an option for 47, we have to start with the end in mind. 1) It's not easy to restore it as we will be compromising on the biologic width distally 2) Pt will develop perio pocket as its hatd to reach and maintain zone Although harsh... its better to extact both and give an implant on 47 if patient desires
Typo error... "Hard to reach"
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option for treatment as follows. 1) Ext of 47,48 after healing restoration of missing 47 2) Ext 48 after healing if perio pocket absent than do RCT / FILLING AND CROWN 3) EXT 47 and with ortho tt 48 move with wire and pull in space of 47 if possible. because 48 is not carious caries in 47 distal half root
@Dr. Ankit Garg sir can you please explain the third point? and how can this be possible?
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first extract 48. placing a graft material would be useful as distal to 47 bone gets compromised after extraction of 48. Rct of 47 can be done as the teeth will sustain easily for next 4 to 5 years. followed by crown. have seen a case like this whr initially 7 was mobile later stabilised with time.
Good that you have shared ur experience with us . Thank you Dr.Namrata !!!
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Sir, 48 is horizontally erupted and due to which it has even lead to caries involvement in 47. first the tooth has to be extracted and then rct should be done for 47. I hope i am meeting your expectation of answer.. if i have missed out something please correct me. Thank you
Ur halfway .. No totally correct . But the treatment modalities are stil not answered !!
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Pain (from a month)...becoz of localized food lodgement or from second molar. Normal mouth opening means 8 is not a main source of pain. treatment for this puzzle.. single sitting rct and restoration of 7 followed by ext of 8 after a month crowning of 7
Go for RCT of 47 followed by extraction of Impacted 48 and Crowning of 47... If their is problem of distal pocket a distal wedge procedure can be performed for pocket irradication
Dr. Choudary. .. Are you hinting towards slow orthodontic extrusion and extraction of third molar to facilitate the gain in bone height distal to 47?
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