I think anyone that knows me knows that I do a lot of my own ends in my practice. Some people hate endo, but I don’t. I love getting patients out of pain and having a solution for them. Here is a case that came in this AM. Now if you follow my posts you know I like to take a bazillion pictures. This patient was in so much pain and the appointment was so long I ended up not taking pics but later wish I did. So its just radiographs but should be a good discussion. BTW I do make fun of presenters who’s entire Implant presentation consists of a bunch of x-rays some of which are iPhone pictures of computer monitors with X-rays, so I guess I can’t talk here. Patient presents in extreme pain. Took 7! count ’em 7 carpules of articaine to get her numb. #3 had previous end with a PA lesion and what looks like an attempted retreat which left a silver point and # 2 large PARL on the palatal root. Started endo on 2 and was going at least attempt a retreat on #3. Once I got into #2 I could not get down the distal canal and could not find the mb2 which was present on the CBCT. Gave patient the option of seeing an endodontist or removing both teeth and doing implants. She was so tired of the pain she opted for the implants. You can see she has some good bone in the furcation for 2 7mm Legacy 2 implants. #2 will be 10mm long and number 3 will be 8mm. Plan on splinting both.
If you go through the hundreds of implant cases here you can see how I deal with immediate molars. I drill through the furcation after flattening the teeth out with a surgical carbide 557 bur, then through that large “hole” I use the 2.3 and 2.8mm pilot drills, section the remaining tooth and go through the series. We ended up using DFDBA and ground up Flagyl 500mg and a Direcgen membrane. Will actually post pics when healed!! Will splint the two and do a screw retained prosthesis.