Page 49 - The Beauty and Sorrow in Endodontics (Chapter 4 - Part 2)

from the radiograph taken at the consultation appointment either. But showed:

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1. Supereruption of 37 due to the lack of opposing contact;
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2. Widened PDL of 36 due to heavy occlusal contact;
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3. Inadequate obturation of 45 and 46 but no signs of any apical lesion or
cracks/fractures

Radiographs taken prior to implant placement:

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1. Large restorations on teeth 16, 15, 14 with intact PDL and no bone loss
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(Fig 50G);
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2. 25 mesial and distal bone loss with widened PDL, confirming the
majority of the occlusal forces have fallen on 25/ 36 (Fig 50H);
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3. Intact coronal structures and attachment apparatus of 14, 13, and 12
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(Fig 50I);
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4. Mesial bone loss of 11, 22 from loss of 21 (Fig 50J);
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5. 23 previously root canal treated with extrusion of the obturation material
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(Fig 50K). The tooth could have been retained with proper root canal
retreatment and/or apical surgery.
6. (Fig 50L, 50M, 50N) The root canal treatments for 34-44 are inadequate,
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however, no apical lesion observed, indicating that the pulp may have not

yet been infected at the time the root canals were completed 30 years
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ago. Bone loss around 44, 41, 31, 33, and 34 is possibly due to the
incorrect placement of the posts resulting in parafunctional forces on the
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teeth over the years. Vertical bone loss at 34D is most severe, suggesting
a large amount of occlusal force on this tooth.

Radiographs taken day of implant placement (Fig 50O).

The patient reported she was having trouble chewing with the removable
denture, and a well-known implant specialist was recommended to her. She

reported that they had not been informed of needing general anaesthetics until
the day of surgery, and wasn’t informed until after the surgery that an implant

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at 47 had been placed at the same time as well. They’ve returned 4-5 times
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