Orthotown October 2019 - 24
message board
Suggestions for Geminated Upper Central
This Townie needs help deciding what to do with this patient's "mega" tooth
dhmjdds
Member Since: 11/16/04
Post: 1 of 9
Has anyone had success with a particular approach to this type of extrawide maxillary central? ■
8/26/2019
christjl
Member Since: 02/07/13
Post: 2 of 9
Diane, I would like to see a PA of #8 to confirm, but the tooth does not look geminated-more
of a mega tooth. I have split centrals when there are two canals, but this one looks like a single,
large canal.
Options are not great. I would talk to them about autotransplantation of a premolar in a couple
of years. Cannot tell the amount of crowding and the occlusion from your photo, but a lower
second premolar would probably give you the best emergence profile for the restorative dentist.
Other options include leaving as-is, decoronation and flipper (although this does not help with
space for 7), extraction and substitution of lateral forward, and extraction and flipper. Extraction
would leave a huge bony defect unless you move teeth forward.
I would discuss transplantation and buy a year or two, and be ready to transplant when roots
are half to three-quarters complete. ■
8/26/2019
emac
Member Since: 11/21/11
Post: 3 of 9
dhmjdds
Member Since: 11/16/04
Post: 4 of 9
emac
Member Since: 11/21/11
Post: 5 of 9
That central is pretty big. I reshaped one that was pretty big, and it ended up looking pretty
good. Not sure how well that would work here, but I don't think it would hurt to try. ■
8/26/2019
I don't suppose you can dig up the photos? ■
8/27/2019
I can't recall the patient's name, but I have "Radar" working on it! We nicknamed the office
manager (30+ years) Radar because nothing gets in or out of here without her noticing. She
remembers him but hasn't got the ID yet.
I did it over several appointments using a disc and other burs. Your case looks like the tooth
is more bulbous/thicker. I don't think you have much to lose by trying reshaping. You can always
extract or do something different later. ■
8/27/2019
tom525
Member Since: 06/18/08
Post: 6 of 9
24
This was a complicated case, but a couple of images of #8 transitional treatment.
OCTOBER 2019 // orthotown.com
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Orthotown October 2019
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