Successful endodontic solutions

Nalin Karunaratne presents a recent case-study.

My patient was a 62-year-old lady with Parkinson’s disease. She also had emphysema and osteoarthritis. This lady was referred from another local practice as she had been suffering from pain and food packing on her lower-left side for the best part of a year, with no solution having been found. She had been to see a dentist who had advised extracting all three teeth, but, seeking a second opinion, the patient was initially referred to our implant surgeon.

A periapical radiograph (fig 1) indicated large distal cervical radiolucencies involving the pulp on LL5, 6 and 7. On the LL6 it extended into the furcation.

Our implant surgeon and I first considered a fixed conventional bridge between the LL5 and LL7, accepting that LL6 could not be saved. However, the prognosis of a bridge in a high-loading area, in a patient with established toothwear from grinding due to stress on two root-treated abutments, was guarded at best.