Just a new segment sharing daily cases by Dr. Nasseh. This is a case of a maxillary second molar with drainage. You can see this and other cases at realworldendo.com
That was a great case , I have never seen a case like that , but I would save the tooth by doing RcT and extracting the DB root for free just to see the result . Amazing case Dr Allen as usual . Egyptian fan 😊
Mohamed Salah k. Good point. Mobility testing in max molars is not as clear as anteriors but I would say this tooth did have about a +1-+2 mobility and +10 probing in the distal.
@@AANasseh I know it has bad prognosis but you Dr. Allen made us curious about every RcT case , my father and mother are dentists but you are the one who made me admire the Endodontics world.
True doc! Completely agree with you. Since the source of infection is not from the tooth you're trying to save , only if further interventions to remove surrounding infection is possible should one consider attempts to save this tooth even to see if it works .
Very interesting case. Extraction is the best option in my opinion as well followed by an implant. Keep posting unsual cases like this one if you have more. Also great endo videos. Wish I was as skilled as you at it. Keep up the good work!
I'm not sure about followed by implant. Implants have a questionable success in this area and if we add the existing bone loss it may also be an unpredictable option. I don't think leaving the area edentulous is necessarily a bad thing. The opposing tooth has contact with the first molar and the patient was already concerned about cost. So, maybe it's best to leave it as is. I told her to see if she finds the empty space disturbing and decide to replace or not afterwards. We'll see. Thanks for the feedback. :)
@@AANasseh I'd repeat the cbct 3 months after the extraction to see if the implant would be a viable option of course. Should've added an "if possible" after "followed by an implant" :) A sinus lift and a bone graft aren't out of question as well if the surgeon thinks that an implant is worth trying... But in the end if the patient makes up his mind that the missing tooth doesn't bother him and it's too expensive just the extraction will do :D
Dr. Nasseh, how often do you root amputation and why would this not be a good case for that. Recontouring DB root at site of fracture, cap area with bioceramic putty. Of course a non-surgical rctx for MB and P roots would also be needed.
That's a great point. I considered this approach but this patient was already thinking twice about saving this tooth (financial reasons) and since non-surgical endo would also require a surgical procedure plus core/crown and also the question of whether the perio defect there would heal considering how long it had been there I didn't think it's very predictable. So, when I gave her the options she elected extraction. But yeah... I think there's a chance it could have been saved. Thanks for the feedback! :) Cheers!
I suspect that in your hands this case could be quite successful with NSRCT followed by a removal of the DB root fragment and backfill with BC RRM. It's certainly what I'd want with my own tooth, but the overwhelming factor, as you mentioned, is the patient's indifference in saving the tooth. Too much risk (although small imo in the scheme of things) in upsetting the patient with failure. Great case and thanks for sharing!
cgoudy88 First, thank you! Second, you’re absolutely right that the main factor here was patient motivation. I don’t like to convince patients of taking risks since I would be promoting the risk; and if it fails, would be responsible for my role in convincing them. So, I lay down the odds and guide them with what makes sense for them based on their values. Cheers!
I am not in Egypt, so extraction is a good treatment for this case. Besides, the economic impact of endodontic therapy with poor(er) prognosis of that tooth.
I haven't watched it yet. I don't want to watch it as every time someone watches it on Netflix it pushes it up the latter and I don't want to help promote that stupid movie! If I get a hold of a free copy I will watch it. I will certainly plan on sharing some thoughts on the topic, maybe with Dr. Koch or with other faculty from the school. It's an important topic and it has come up several times. Thanks for the comment. :)
@@AANasseh actually i found many videos recently attack root canal, as if its the reason for all body diseases... I cant imagine how to a precious disinfection therapy be a cause of disease...
I think extraction was the best choice too, cb ct in this case was certainly helpful.. Question, if you don`t do de cb ct, and do the endo? what you say/relation for the patient after don`t get the result wish?
However doc if Implant is to succeed similar interventions are needed . Then one is confronted with the same question, should attempts to save the existing tooth be made ? Do you agree ?
If I was a patient I would like to give a chance and let you share the result for educational purposes. But when I'm a dentist I would extract because the success rate is not that high and I will not take that risk as a dentist but I will take the risk as a patient 😁
Yeah. It's true. And I've done cases like this at no charge to the patient just to see what happens... I guess donating my time to learn is the way I look at it... but here, the problem was the investment that had to take place afterwards as well. It's a tough call to ask the patient to pay when you know the odds are questionable and the patient is otherwise not interested in taking a chance. You have a good point.
I think this is the best review.i don't have to use my head to think further . The cbct quite clearly shows all canals engulfed as radiolucent. Clinically HOW mobile was the tooth? Allen hasn't mentioned that point for us to think of taking a chance.
The mobility was about +1. Although it's hard to determine mobility in a maxillary second molar. The more important problem was the deep probing in the distal (+10mm).
Extraction since it will need a core and crown anad surgical intervention .. placing implant overthere is the best option Sorry dr allen but i have a qustion Why alot of vedios here on channel not complete .. ?
Some of those were excerpts for sending people to the website for the full video. I’m not doing that anymore. Decided to share 90% of all website videos for free. :)
Dr. Allen amazing video as usual , u really changed my way for rct I love watching u r videos I learned alot really, but I have a question about the case if the patient was capable financially would u go for surgical treatment, and removal of fractured root and using bc butty , would it have chance to success!?, and thanks alot
Technically, every outcome is possible. The question is whether it's probable. Given the +10mm probing in the distal and the patient's lack of motivation I didn't go for it; but yes, if the patient was motivated in trying to save the tooth and was fully aware of the possibility of losing it despite the cost, then you can try and find out. Technically, no one really knows the future.
Since the palatal root act as fulcrum during cycles of mastication ...I don't think long term prognosis of this tooth minus disto buccal root....going to good...even after RCt and cap.
Harshill Matta I agree. Unfortunately no one knows the future but it’s definitely a factor to consider and along with patient ‘s lack of motivation it tilted the balance towards extraction for me. Thanks for the feedback! :)
That was a great case , I have never seen a case like that , but I would save the tooth by doing RcT and extracting the DB root for free just to see the result . Amazing case Dr Allen as usual .
Egyptian fan 😊
Mohamed Salah k. Good point. Mobility testing in max molars is not as clear as anteriors but I would say this tooth did have about a +1-+2 mobility and +10 probing in the distal.
@@AANasseh I know it has bad prognosis but you Dr. Allen made us curious about every RcT case , my father and mother are dentists but you are the one who made me admire the Endodontics world.
True doc! Completely agree with you. Since the source of infection is not from the tooth you're trying to save , only if further interventions to remove surrounding infection is possible should one consider attempts to save this tooth even to see if it works .
Loved you diagnosis and treatment plan 🙂👍🏼💐
Very interesting case. Extraction is the best option in my opinion as well followed by an implant. Keep posting unsual cases like this one if you have more. Also great endo videos. Wish I was as skilled as you at it. Keep up the good work!
I'm not sure about followed by implant. Implants have a questionable success in this area and if we add the existing bone loss it may also be an unpredictable option. I don't think leaving the area edentulous is necessarily a bad thing. The opposing tooth has contact with the first molar and the patient was already concerned about cost. So, maybe it's best to leave it as is. I told her to see if she finds the empty space disturbing and decide to replace or not afterwards. We'll see.
Thanks for the feedback. :)
@@AANasseh I'd repeat the cbct 3 months after the extraction to see if the implant would be a viable option of course. Should've added an "if possible" after "followed by an implant" :) A sinus lift and a bone graft aren't out of question as well if the surgeon thinks that an implant is worth trying... But in the end if the patient makes up his mind that the missing tooth doesn't bother him and it's too expensive just the extraction will do :D
Very interesting case and discussion. Given the patient's mindset and the circumstances, I think you made the right call recommending extraction.
Thank you doctor for sharing this interesting case. 👍👍
Dr. Nasseh, how often do you root amputation and why would this not be a good case for that. Recontouring DB root at site of fracture, cap area with bioceramic putty. Of course a non-surgical rctx for MB and P roots would also be needed.
That's a great point. I considered this approach but this patient was already thinking twice about saving this tooth (financial reasons) and since non-surgical endo would also require a surgical procedure plus core/crown and also the question of whether the perio defect there would heal considering how long it had been there I didn't think it's very predictable. So, when I gave her the options she elected extraction. But yeah... I think there's a chance it could have been saved. Thanks for the feedback! :) Cheers!
@@AANasseh great thinking and perfect planning for your patients
I suspect that in your hands this case could be quite successful with NSRCT followed by a removal of the DB root fragment and backfill with BC RRM. It's certainly what I'd want with my own tooth, but the overwhelming factor, as you mentioned, is the patient's indifference in saving the tooth. Too much risk (although small imo in the scheme of things) in upsetting the patient with failure. Great case and thanks for sharing!
cgoudy88 First, thank you! Second, you’re absolutely right that the main factor here was patient motivation. I don’t like to convince patients of taking risks since I would be promoting the risk; and if it fails, would be responsible for my role in convincing them.
So, I lay down the odds and guide them with what makes sense for them based on their values.
Cheers!
Thrilling story
I am not in Egypt, so extraction is a good treatment for this case. Besides, the economic impact of endodontic therapy with poor(er) prognosis of that tooth.
Extraction is the best decision the tooth according to xray surrounding by sever periodental infection plus fracture distal root no way to save it
Thank you 🙏🏻 for sharing such a great knowledge 🌹
Appreciations for ur choice..Dr
Dr. Nasseh, did you watch "Root Cause" on Netflix ? and what is your opinion about it?
I haven't watched it yet. I don't want to watch it as every time someone watches it on Netflix it pushes it up the latter and I don't want to help promote that stupid movie! If I get a hold of a free copy I will watch it. I will certainly plan on sharing some thoughts on the topic, maybe with Dr. Koch or with other faculty from the school. It's an important topic and it has come up several times. Thanks for the comment. :)
@@AANasseh actually i found many videos recently attack root canal, as if its the reason for all body diseases... I cant imagine how to a precious disinfection therapy be a cause of disease...
I think extraction was the best choice too, cb ct in this case was certainly helpful..
Question, if you don`t do de cb ct, and do the endo? what you say/relation for the patient after don`t get the result wish?
Thanks for sharing
I agree Dr.
However doc if Implant is to succeed similar interventions are needed . Then one is confronted with the same question, should attempts to save the existing tooth be made ? Do you agree ?
If I was a patient I would like to give a chance and let you share the result for educational purposes. But when I'm a dentist I would extract because the success rate is not that high and I will not take that risk as a dentist but I will take the risk as a patient 😁
Yeah. It's true. And I've done cases like this at no charge to the patient just to see what happens... I guess donating my time to learn is the way I look at it... but here, the problem was the investment that had to take place afterwards as well. It's a tough call to ask the patient to pay when you know the odds are questionable and the patient is otherwise not interested in taking a chance. You have a good point.
I think this is the best review.i don't have to use my head to think further . The cbct quite clearly shows all canals engulfed as radiolucent.
Clinically HOW mobile was the tooth? Allen hasn't mentioned that point for us to think of taking a chance.
The mobility was about +1. Although it's hard to determine mobility in a maxillary second molar. The more important problem was the deep probing in the distal (+10mm).
Thank you..the extensive radiolucency involving furcation no doubt is a bad prognosis with added distal root hanging.I go with you totally.
Thank you 👌👌great case
Hey dr, what is the best method for filling canal between Lateral condensation and thermal filling?
Interesting!
Extraction definitely the best option
Extraction since it will need a core and crown anad surgical intervention .. placing implant overthere is the best option
Sorry dr allen but i have a qustion
Why alot of vedios here on channel not complete .. ?
Some of those were excerpts for sending people to the website for the full video.
I’m not doing that anymore. Decided to share 90% of all website videos for free. :)
Dr. Allen amazing video as usual , u really changed my way for rct I love watching u r videos I learned alot really, but I have a question about the case if the patient was capable financially would u go for surgical treatment, and removal of fractured root and using bc butty , would it have chance to success!?, and thanks alot
Technically, every outcome is possible. The question is whether it's probable. Given the +10mm probing in the distal and the patient's lack of motivation I didn't go for it; but yes, if the patient was motivated in trying to save the tooth and was fully aware of the possibility of losing it despite the cost, then you can try and find out. Technically, no one really knows the future.
Thanks alot dr Allen , wish u come to Egypt again thanks alot for everything :)
I would have go for xla too.
I most probably would have done the same still I find myself more and more doing these exotic cases pro bono😉
Since the palatal root act as fulcrum during cycles of mastication ...I don't think long term prognosis of this tooth minus disto buccal root....going to good...even after RCt and cap.
Harshill Matta I agree. Unfortunately no one knows the future but it’s definitely a factor to consider and along with patient ‘s lack of motivation it tilted the balance towards extraction for me.
Thanks for the feedback! :)
Most welcome Dr.
Ext. Implant