Dentaltown April 2020 - 48
message board
At What Point Do I Punt With
This Very Large Cervical Lesion?
A Townie asks for treatment advice for his patient: Crown? Implant?
smiledochill
Member Since: 03/11/04
Post: 1 of 82
This is a great patient. Motivated to save his teeth or replace with decent options if needed.
He has NCLs (cervical abrasion, grooves, abfraction) on several teeth, but #13 is getting out of
hand. We've tried direct bonding to at a minimum let him wear away the composite, but they
are simply not staying in place.
I really should have gotten a photo to show it, but this area of tooth loss is tucked in a tight
spot. He has sharp/narrow recession, resulting in almost vertical lines of gums and the cervical
extent of the lesion is 6-9mm apical to the crest of the ridge interproximally. Visually, he has
a very near if not actual pulp exposure. (I wasn't going to jam an explorer into his pulp at his
hygiene check and find out.)
From a purely mechanical standpoint, I'm concerned there isn't enough tooth structure
left at the bone level to support the crown even if we did RCT, post and crown. I'm inclined to
recommend extraction and implant placement, but when I think of that, I feel like I'm taking
out a tooth that "isn't even bothering him." When I think about restoring it, I can't see an option
that results in a prognosis good enough to warrant the time/cost of doing what needs done. Any
advice/help is greatly appreciated. ■
1/23/2020
4th Crown and Long
Member Since: 01/21/15
Post: 2 of 82
I bet they keep popping out not because of bonding but because he is occluding on that
tooth and flexing it. I would try one more time, but take the tooth basically out of occlusion. A
crown is going to be really tough unless you have access to enough tooth below the defect for
some ferrule. ■
1/23/2020
ToothNinja99
Member Since: 01/07/10
Post: 3 of 82
48
Am I the only one who takes a two-second look at this tooth and says "extract"? ■
1/23/2020
APRIL 2020 // dentaltown.com
DT0420_MB3_Punt_AG_V2.indd 48
3/19/20 10:40 AM
http://www.dentaltown.com
Dentaltown April 2020
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