Treat or Extract? [Part I]

Assuming there is no mobility, no gross decay around the existing FPD, and no history of recent and significant periodontal changes in the area I would definitely recommend endodontic therapy. In my eyes that is the most conservative treatment option with a high rate of success, especially in consideration of her good home care and routine perio therapy. Since she is restoring the lower arch I'll also assume money is not a significant issue and the only other the patient is interested in would be implants. Not that implants can't be done here successfully, but it appears grafting would be necessary as well as much more treatment time compared to endo therapy.

I agree with the first post. I would elect to treat with microscope assisted root canal therapy. The age of the patient is the main determinant of treatment course. At 63 years of age, the periodontal disease is slow progressing and it is likely that this bridge will be maintained for life. Her statistical mean predicts she has about 15 years of life left. Since her dental behavior shows regular routine visits it's likely the periodontal condition will remain under control.

I agree with the first and second posts. in a case of extraction it seems like she will need bone grafting and sinus lift procedures due to the resorption of the bone in his area.So suggesting her to do rct under microscope is a good idea.

I will be the first radical to say extract, sinus aug, and 2 implants. The periapical lesion is very large, the furcation is more likely Grade 3 if debrided. The pros of treatment now, while the patient is still young and healthy are numerous. What if the RCT treatment is fine for 5-10 years and fails again. Now the patient is 73. It is very likely that either the endo or perio will fail. This patient has only 2-3mm of supporting bone coronal to the sinus. However, I recently treated a 94 year old with a PARL slightly larger than this on the MB root with an acute infection. The family and I decided together to only debride the periapical lesion, which was the size of a quarter (because of her age). Often the lesion looks fairly small on the pa but is clinically MUCH bigger. Will monitor her and let you know. Looking forward to the solution.

I have to agree with Gayle on this. The prognosis for a bridge on an endo treated molar is not good for 10+ years. Add to that the lack of attached gingiva at the molar, the furcation involvement, and the amount of existing bone at the pontic space it's a no brainer. Take advantage of the bone that is there now. It will only be lost over time and now you are doing sinus augmentation in a site that will be decimated by atrophy and infection in the future. I also feel that there is a lesion at the DB root as well. In this case, I feel implant replacement is the most conservative treatment. Endo treatment is just a patch and will only create more risk in the future.

BE CONSERVATIVE ,AS LONG AS PT MAINTAINS HYGIENE ,MICROSCOPE ASSISTED RCT IS BETTER OPTION,THAN SINUS LIFTS OR BONE GRAFTING AND IMPLANTS

Sectioning the bridge and placing two implants is not sufficient. To complete the case properly the crown on the premolar must be replaced as well. Failure to do so would leave a flat broad contact area that would certainly lead to papillary creep and a hygienic issue. Replacing the crown on the premolar also exposes it to a risk factor for endo.

Always difficult to make a treatment recommendation of an individual tooth. Would like to know her past history especially if it relates to structural failures of other teeth in the past. She will not lose this tooth due to perpetually attachment loss. Endodontic therapy will treat the apical periodontitis. It's short root trunk and the remaining tooth structure post endodontic treatment will have a greater impact of it's prognosis. This gets complicated as its opposing teeth appear to be implant retained restorations.