Hopeless Dentition?

Hi, No way that's hopeless dentition in my practice. Only restriction on this case in my practice is, if the patient wants Veneers. I would strongly advised against it, but otherwise if I can educate the patient and stall that Perio issues, patient should be fine for long time. Splintting some of these teeth to get them even longer is something I could do, if Patient's motivation is to keep as much of his/her teeth for as long as possible and is going to be compliant with oral care. I might advise patient against doing a lot of Root canal procedures, that's where I think I would discuss implants, i.e. if Teeth get Irreversible Pulpitis, now we have to make a judgement call based upon patient's health, values and finances. At most the next need for this patient is going to be Mandibular anteriors. Just my $0.02

It would be nice to see some follow up x-rays of all the teeth. Also, at least from your panorex, the maxillary anterior teeth look like they have better bone than several of the other teeth, eg maxilary premolars and molars. I would love to see what the bone looks like around these teeth 3 years later. Thank you

How do you determine what a hopeless dentition is? Perhaps if you were more sure of your standards of care this wouldn’t be phrased as a question, but more of a statement. When one considers the overall health of a patient in relation to his or hers own teeth it is multifactorial. 1. Is the patient comfortable, 2. Does the patient have any infections, 3. Is this a situation that the patient can maintain and enjoy stability of his dentition, 4. Is this creating a secondary issue relative to his or her organs-heart, lungs pancreas-ie the role of inflammation 5. Does the patient smoke and how does this effect the prognosis, 6. Does the patient have any diseases that effect the long term outcome-ie diabetes, valvular disease, osteoporosis. The factors are endless and you are the practitioner who needs to use your education to make this judgment. Good luck!

There should be no such thing as a hopeless dentition in dentistry. A periodontally compromised tooth that has only 20 percent bone left and is WITHOUT DISEASE is not hopeless. We assume that oral disease process cannot be stopped/controlled and at the current level of periodontal treatment technology, it often cannot be treated conservatively and inexpensively ( as it should be ). Innovations in periodontal therapy and PREVENTION could change all that. Innovations in implantology will never change that.

Thank you for raising the topic of “to retain or to implant?” again. It is pleasing to see that there are a considerable number of replies indicating they would save rather than extract the teeth in this case. The more experience dentists get, the more they will realise than implants can have as many limitations, complications and failings as restoring natural teeth. Likewise, if done properly, placing implants and restoring them can have a good long term prognosis – but so can properly restored teeth. Obviously there are exceptions to this – both with implants and teeth. When Timothy introduced this philosophy of salvaging teeth (rather than extracting and implanting) about a year ago, the majority of responses were for extraction. In fact many thought a relatively simple (but complex) restoration was a hopeless cause. It is therefore pleasing to see a much more balanced approach is being considered by many practitioners with this current case. Of course there are multiple factors to consider when making a final treatment proposal to a patient, but I would encourage all practitioners to consider rehabilitation of existing teeth rather than extraction and implanting. Retaining teeth provides more options and is not a one way street. Like it or not, implants can leave the patient with considerable problems if the treatment is not successful. Well done Tim. I too would like to see the 5 and 10 year follow up results. It is only when some dentists see that hopeless cases are not really hopeless that they will become believers.

The mentality is disturbing at times when I see xrays like this where someone else has already talked to the patient about how it's in his/her best interest to take all the teeth out and go with some kind of implant hybrids. If there aren't inflammation, perio abscess, and/or mobility, then that dentition isn't hopeless. even if some are, I've found out over the years that benefits of implants are good but get overexagerated at times to patients. When/if the expensive implant treatments fail, the patient are worse off.

I cannot see significant bone loss on the maxillary incisor teeth on the readiograph provided. It would be helpful to this discussion if properly angled peri apical radiographs were posted along with pre op clinical photo, probing depths, and mobility classification. From the limited information provided I likely would have only provided periodontal treatment and "save" the maxillary incisors.