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The study titled ‘Interdisciplinary Endodontics’ was originally published by Dentistry Today.
Endodontically treated teeth could be one of the weakest links in restorative diagnosis and an effective treatment plan. It can also be the weakest link in the success and failure of an interdisciplinary treatment procedure.
This article aims to help dentists improve the success rate of their interdisciplinary endodontic treatment plan by showcasing 3 patient cases. All the patient’s care records are from 18-26 years post-treatment. They might not have been the easiest treatments but they were the proper treatment procedures for their times. The primary goal with these 3 cases is to help dentists do the following:
Basis of the Treatment
The interdisciplinary endodontic treatment procedure for each of the 3 cases was based on biology, structure, and aesthetics. Specifically, can it be possible to clean and seal the root canal system portals of exit (POE) either surgically or non-surgically? Is the periodontal state healthy or is it possible to make it? Structurally, is there enough ferrule height and width? Is there 4.0mm from the height of bone to the height of ferrule? Aesthetically, is the dental aesthetics enhanced by the endodontic tooth, and if not, can it be enhanced?
Case Studies
Case 1:
The patient suffered from a residual sinus tract-tracing. The location was the lateral wall of the maxillary right central incisor after a third aesthetic bridge attempt
Biologic Considerations:
What is the pulpal status of multiple abutments? Is it possible to treat the underfilled anatomy of the tooth number 8 and seal existing inaccessible POEs? Could the post be taken out nonsurgically and can the underfilled anatomy be located, cleaned, and blocked up? Is the periodontal condition in a healthy state?
Structure Considerations:
Could the FPD be extracted without damaging the teeth or FPD? Note that FPD was not bonded with zinc phosphate cement. Could the post be extracted without damaging the ferrule?
Aesthetic Considerations:
If an endodontic operation was chosen, could black triangles or scarring be a risk factor? Due to the high smile line, conducting an operation was not contraindicated. If surgery is carried out for the tooth, was about non vital pulp in another tooth? How to access through FPD or remove existing FPD? What about implants and removals? The patient wanted the bridge to get his smile right after his vehicle accident. He showed no interest in another implant or bridge and came to terms with a predictable nonsurgical interdisciplinary treatment plan.
Interdisciplinary Treatment Planning and Sequencing:
The idea was to extract the bridge successfully and cement it permanently after having firm evidence of sinus tract healing. Nonsurgical endodontic treatment for tooth number 10 and retreatment for tooth number 8 was also planned.
Case 2:
The patient had a sinus tract in tooth number 8 and had suffered a lot of accidents to her maxillary anterior teeth.
Biologic Considerations:
Is surgical or non-surgical endodontic treatment predictable since the lateral POE was towards the palatal, making it inaccessible for preparation and obturation? The patient also had aspirations of modeling and did not want surgical scarring.
Structure Considerations:
Is it possible to preserve the ferrule through a nonsurgical approach?
Aesthetic Considerations:
The patient wanted an uneven gingival smile line to be corrected. The prosthodontist and orthodontist agreed to sequence their treatment plans after they had clarity on the endodontic status of the maxillary right central incisor.
Interdisciplinary Planning and Sequencing:
Once the nonsurgical endodontic retreatment of tooth number 8 was carried out, orthodontic treatment along with tooth correction of tooth number 8’s gingival levels was conducted. Aesthetic restorative dentistry was conducted as per requirements.
Case 3:
The patient showed palpation and percussion sensitivity in tooth number 8. She wanted to extract the black region between the gingiva and tooth. Her dentist recommended covering the dark halo with a crown. He also advised internal bleach to eliminate dark reflection into the gingiva, even after fitting a new crown.
Biologic Considerations:
A radicular lesion of endodontic origin (LEO) was present due to sealer obturation, probable coronal leakage, and seal breakdown of the silver cone.
Structure Considerations: The endodontic preparation was shaped when preserving ferrule and root width.
Aesthetic Considerations:
Once endodontic symptoms were no longer present, internal bleaching was done.
Interdisciplinary Planning and Sequencing: Safe internal bleaching and a successful nonsurgical endodontic retreatment were carried out and a new crown was fitted.
Conclusion:
Is it the best practice to choose the same 3 endodontic interdisciplinary treatment procedures today? The answer is yes. The art of saving endodontic treated teeth may have been lost. However, in the right hands, a consensus diagnosis, proper interdisciplinary planning, and saving endodontic treated teeth are very much possible today.
Endodontic interdisciplinary treatment planning will ensure patients an appropriate solution that will best suit their needs.
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