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60 | CERECDOCTORS.COM | QUARTER 4 | 2014
| | | D I S C U S S I O N F O R U M
Farhad Boltchi (Faculty) | Arlington, Texas
So youwent fromthe ’ole distal tilt to the good ’ole
mesial tilt? (Big grin) ...
I can’t argue with Baron’s treatment decisions here.
With decay into the furcation or deep subgingival decay
the cost:benefit ratio will probably not add up to try to save
these teeth.
However, Tom has a very valid point with regard to the
“disposable tooth mentality”:
I was at a very high-end, by-invitation-only interdisci-
plinary meeting earlier this year. The participants in this
grouparetop-notchclinicians,halffromtheU.S.andtheother
half from Europe. It was interesting to see the philosophical
differences between the U.S. dentists and the Europeans.
The treatment-planning session this yearwasmoderated
by Bob Winter and Josef Diemer (an exceptional German
general dentist), who put up several of his own cases for
treatment planning discussion. Without exception, all
of the U.S.-based dentists, including myself, condemned
many of the teeth to extraction and then implant replace-
ment. The majority of the Europeans, on the other hand,
opted to save the teeth and Dr. Diemer then showed how
beautifully he saved and restored the teeth with endo and
adhesive dentistry for a successful long-term outcome.
One of the greatest researchers in perio and implant
dentistry, Professor Klaus Lang, once told me something
that has stuck with me, and in paraphrasing him I want to
pass it on to you guys as it is great food for thought:
I bet you that every day all of us see hundreds of teeth
that have been in our patients’ mouths for 40 years. But,
I am pretty sure very few of us, if any, have seen a single
implant that has been in the patient’s mouth for 40 years
(I know I haven’t).
Baron Grutter
This morning, I was trying to edit this post, as
it was brought to my attention that I forgot the
Implant info.
Patient went to endo for re-treatment after O&R in my
office. Endo determined it was no longer predictably treat-
able and would need to be replaced at some point. Patient
opted for replacement, rather than seating the crown with
questionable long-term prognosis.
During the TE, the tooth was essentially mush and came
out in about 100 pieces. The bone was extremely dense and
I had to remove the implant twice before I could get it to
an acceptable depth. Would
have liked it a bit deeper, but
2 mm sub-crestal will have
to work. I grafted the gap to
minimize crestal bone loss.
Threemmhealing abutment
placed and sutured closed.
Baron Grutter
Here’s my first Maxillary Molar Immediate with
BSP. Most molar immediates could probably be
done freehand, due to the large ridge width and the fact
that you can usually use the pulp chamber to center your
pilot drill. However, when reviewing the CT of this case, I
could tell that I wanted to go guided. As you can see from
my Pilot Hole PA,
I needed to bring
my implant signif-
icantly mesial to
the tooth center.
All in all, the case went
great. Other than having a
tiny mouth, it went great.
First, I de-coronated, ranmy
pilot, checked orientation,
surgical TE, curetted the