Implant in 30 before or after extraction of 31?

If #31 is in occlusion and there's no infection... leave it. Get the scan and implant done.

Is there a plan to place an implant at 31 also?

I would usually do both the extraction and the implant at the same time. With a Xenograft in the socket of #31 it will be stable. Many times I will implant #31 at the same time too, depending on how close to the nerve the tooth root is on the CT scan.

Not sure of the prognosis for 31 but it looks good on the x-ray. Clinically it could be another story. If the tooth 31 is good then just do 30 alone. If 31 needs to be extracted due to some clinical issues, then I would extract, graft, wait 3 mos and get a radiographic guide made before another cbct is taken. Then do both at the same time. You can do an immediate post 31 extraction but there are higher risks which will set you back more in time and probably costs as well. I like predictable. Like I heard from the AAID meeting recently held in Newport Beach, one of the speakers said something to the effect of "The slower I go, the faster I get there"

It would be nice to know what's upstairs. If 31 keeps 3 from supraerupting, then it serves a noble purpose until it's time to go to bed for the night. And I rarely find the need to replace second molars as long as we have it nailed first molar forward. (Also, sometimes there's not enough room for a torque wrench driver on second molars.)

A CBCT of the area would be a really great diagnostic tool to utilize prior to the placement of the implant in tooth 30. I believe there is a reasonable possibility the mesial root of tooth 31 is fractured which could be verified with a CBCT. If the root is fractured then extraction done together with the implant would be recommended. I would not want to place an implant next to an area of potential infection.

While I agree that CBCT is practically the standard of care for implant placement today, I'm not sure that a crack in the mesial root of 31 is likely to produce the extent of infection that would endanger an implant in the 30 location. If one is concerned, conventional imaging on a monthly basis could be performed to rule out that possibility. Again, I'm simply suggesting that 31 might serve a useful purpose from an occlusal/clearance standpoint for the four months before 30 can be restored after implant placement (or even during the crown fabrication period).

31 definitely shows some trouble going on around the mesial root. I would place an implant in 30 site. I would remove 31 if symptomatic and graft same time 30 site is implanted. place implant in 31 site and deliver crown to 30 site in 3 months at the same time.

I’m the patient who had the question above. My endodontist told me he saw signs of an infection in No. 31. However, he said the infection was draining and I could hold off on the extraction for a short while. So, for the present, I don’t plan to do the No. 31 extraction (unless the infection gets worse and becomes painful) and/or the initial implant work on No. 30 for a few weeks as I’ll be away from my home area. As for doing an implant on No. 31, as well as on No. 30, I’m leaning towards just doing No. 30, as suggested by one dentist’s comments. I should also add that I’ll be turning 80 this May. Thanks much for all your helpful comments!

This is a variable situation. If there is upper occlusion I would consider keeping # 31, to maintain the occlusion,however their is a possible problem with the medial root. Extract it # 31 place bone with an immediate implant along with # 30. Doing both together would be the best option.

It looks like the messiah root may be involved. A CBCT would be a nice aid to diagnose any fracture and or infection in #31 and to evaluate the site of #30. Properly mounted study models would be of a great assistance . Stay with the diagnostic basics. The more hurried you get the more hind you become. (To quote one on my dental school professors.)

Coronal leakage is the death of all good (endo) intentions. So what would be wrong with crown removal, revision of the endodontic treatment and placement of a cadcam temp? Unless it reveals a fissure during the process, that is. I don’t think it’s unlikely that this molar can be saved for another couple of years.

I think most of had figured that out. Cracks like that cause occult infectious problems in their immediate area, which are the source of the pain with chewing, or may not be particularly painful at all. We'd still like to know what's upstairs. If the presence of this tooth prevents the upper molar that will occlude with your #30 implant, you should keep it as long as you can tolerate it. If there's nothing upstairs that #31 participates with, you might as well have it removed at the same time as implant placement #30. Can you provide us with imaging of the teeth directly above this area? It's been an interesting trip, but we need a bit more evidence.

Whoops! Left out supraeruption of the upper tooth that might occlude with #31. If #3 actively erupts during the 4-month implant process, there might well be a loss of the necessary room to restore the implant, which would defeat the purpose of placing it.

As stated before by very knowledgeable DDS ‘s, placement of implant at #30 in combination with extraction plus graft on #31 is very ideal for a few reasons. I will give my anecdotal evidence and anyone can tell me otherwise. 1. For implant positioning and spacing of the interimplant distance 2. Cost and time may be reduced 3. Bone preservation on mesial of 31. 4. Save time for Patient to have a final crown sooner. So, do the ideal treatment rather than some patchwork implantology. Also, CBCT is Great for finding be nerve canal, measuring bone width, but I have found few Endodontist that can difinitely say they see a Fracture. I agree there is a Endo-Perio lesion that is “draining” in Laymen’s terms, which is why there is only a one wall defect. More bone will “erode” in that one wall defect by keeping #31. I have seen this scenario play out dozens of times...also supraeruption of maxillary molars takes many many years and there is no space a great surgeon can’t put an hex/ conical wrench in the mouth. Don’t worry about those things....just need the right tools and angles.