Page 60 - CEREC Q4 | 2014

58 | CERECDOCTORS.COM | QUARTER 4 | 2014
| | | D I S C U S S I O N F O R U M
Thomas Kauffman
Hello Baron, thank you so much for posting
your photos. The mere fact that you are docu-
menting your treatment is a tribute to your attention to
detail. We all can take a lesson from that. Now, I have to
disagree with your assessment and conclusion. If those
(plural) weremy teeth, theywould not have been removed.
Because implants are not, nor have they ever been,
a perfect solution to the possibility of a missing tooth.
There is a growing groundswell of “academic and profes-
sional” protestation directed toward the “disposable tooth
mentality.” I, as a member of the American Academy of
Perio, am accessible and aware of the dialogue present on
their web portals discussing this topic and others. I am
sure that Farhad would agree. Several times in the course
of a year, my main go-to endodontist, Alan Goodman, have
a conversation. It goes something like this.
“If this were your tooth, what would you do?”
“OK, that is what I would do also. Talk it over with the
patient and let me know what to do.”
Inbothof yourcases, if itweremy tooth,NOTITIANIUM.
Just a thought.
Baron Grutter
Thanks. I appreciate your compliments. I assure
you, if these were my teeth, my wife’s, my moth-
er’s or my son’s (at 2.5 y/o, he might not qualify for the
analogy), my recommendation would not change. In my
book, decay into the furcation is beyondmy abilities to treat.
As is a molar with no coronal tooth structure taller than the
gingival margin. Perhaps I need a new endodontist? ;-)
Ben Jump | Newark, Ohio
Your treatment based on what I saw here was
appropriate and well done. If you saved either
of these teeth and when (not if ) they failed in the future,
who would this benefit? I always ask myself the question:
Out of all the implants we place, what percentage of them
are replacing teeth that are failed endo therapy? In my
practice it’s probably 90 percent. Is it the tooth that failed
or the endo therapy that failed? Does it matter? It’s still a
failure.
Endo is a great therapy when cases are appropriately
chosen. And in your cases, your decision to place implants
appears to be most appropriate.
This extraction was absolutely miserable. If you look
at the distal root, you’ll notice a nice fat bulb at the apex.
That thing toyed with me for nearly an hour and a half.
Both roots actually came out in about 10-15 pieces each.
My DAwent through about six disposable surgical suction
tips. Fortunately, she’s got about 3 mm of bone buccal and
lingual to the tooth, so I was really never in any danger of
fracturing either plate.
Another nice thing about “fatty” implants, I basi-
cally removed two-thirds of the furcal bone during the
TE. However, never did I care, as I knew I would just be
removing it during my osteotomy creation. As you can see
from the paralleling pin, I definitely got the ’ole distal tilt
(almost perfectly parallel to the premolar, lol). Anyway, not
too difficult to upright, particularly once the furcal bone
was all but eliminated.
All in all, I’m pleased with the placement, just not with
the time it took. But honestly, the implant took less then 20
minutes to place.
BTW, I forgot to mention that with all of my molar cases,
I’ve used Emil’s Drillstops. Here’s the thing: in these cases, I
didn’t really use them for a stop, other than during the initial
pilot. I really just used them for a visual reference. I find it
MUCHeasier to get a proper feel for the needed orientation
of the drill with a 6 mm (or even his 5 mm) cylinder up top.
In particular, when you’ve got a molar edentulous area that
is about 9 mm wide by 12 mm long, trying to properly posi-
tion a drill can be a real pain. Also, I can select a stop, such
that when it’s level with the gingiva or some other land-
mark (similar to endo stoppers), I know I’m deep enough.
Anyway, thought I should mention it. I, unfortunately, don’t
have any images to demonstrate this, sorry.
#19 - 7.0 x 10mm BIO|Molar with FDBA at the occlusal
gap (I know, probably not necessary).