by Scott Froum, DDS, Editorial Director; and Marcus Johnson, DDS, MSD
When faced with an infection from an endodontic, periodontic, or combination lesion, is it worth trying to save the tooth involved versus replacing it with a dental implant or bridge? Dr. Scott Froum, Perio-Implant Advisory's editorial director, and Dr. Marcus Johnson explain how to diagnose the infection and suggest questions to ask as you decide upon treatment.
Many clinicians struggle with the question of whether a tooth experiencing an infection from an endodontic, periodontic, or combination lesion is worth trying to save. These teeth may require root canal, periodontal, and restorative therapy. Is it worth it to try to treat and save the tooth versus taking it out and placing a dental implant or bridge? This article will guide you through this decision by explaining how to diagnose the infection and suggest questions you should ask when deciding upon the method of treatment.
1. What is the etiology of the infection?
a. Treatment is dictated by etiology; furthermore, so is prognosis
2. What is the clinical/radiographic presentation?
a. How mobile are the teeth: Class I, II, or III?
b. How severe is the probing: less than 5 mm, 5–8 mm, or greater than 8 mm
c. Is the furcation involved if multirooted teeth? If so, is it Class I, Class II, or Class III?
d. Is the bone loss vertical or horizontal, and what is the severity?
e. Is there a sinus tract and/or edema present?
3. Restorability: Can the tooth be restored with a restoration that will last?
a. Can coronal and radicular dentin be preserved after caries removal?
b. Can contamination of the root canal system be avoided?
c. Can a proper post and core be placed without causing root fracture?
d. Is adequate ferrule present?
e. Is adequate interocclusal space present to allow for crown placement?
f. Is crown lengthening needed, and if so, how much reduction is necessary?
4. What are the costs and compliance involved?
a. Can the patient afford treatment by multiple specialists?
b. What are the anticipated maintenance fees?
c. Is the patient motivated, and will the patient comply with long-term follow-up?
5. What are the alternative treatment options to present to the patient?
a. Hemisection/bicuspidization of multirooted teeth
b. Root amputation
c. Guided tissue regeneration
d. Extraction and subsequent implant therapy
Scott Froum, DDS, a graduate of the State University of New York Stony Brook School of Dental Medicine, is a periodontist in private practice in New York City. He is the editorial director of Perio-Implant Advisory e-newsletter, as well as a contributing author for DentistryIQ and Dental Economics. Dr. Froum, a diplomate of the American Board of Periodontology, is a clinical associate professor at both SUNY Stony Brook and the NYU Dental School in the Department of Periodontology and Implantology. He serves on the board of editorial consultants for the Academy of Osseointegration's Academy News. Contact him by email at email@example.com or through his website at drscottfroum.com.
Marcus Johnson, DDS, MSD, studied at New York University College of Dentistry. After completing a one-year residency in the Bronx through Luther Medical Center, he earned his specialty certificate and master’s degree from Case Western School of Dental Medicine in Cleveland, Ohio. Dr. Johnson is in private practice limited to endodontics in a group practice on Long Island and has his own practice, City Endodontics, in Midtown, New York.