Hopeless/Non-Restorable #8: 33 months post restoration

Great result, very nice soft tissue profile and gingival architecture. No reason this restoration should not last several years

Patients ALWAYS appreciate attempts at restoring their natural teeth and become more receptive to other treatments ( implants, etc. ) once that appreciation and trust is established.

As a general dentist who places 100s of implants a year, I would say keep it simple. In my office, this would be clear cut root canal, post and crown. If I am iffy about long term success, I apply money spent on endo and crown towards the implant if it fails in the first two years. Rarely have I had to revisit with implant. It’s honest dentistry. Patients are well aware of their options and 9/10 times will rather the noninvasive approach. Patient selection is also key. We deal with a ton of mechanics when we are treatment planning these cases. It’s only one tooth and occlusion seems to be fine. And patient has a silver fill endo on #7. Can’t get more old school than that. Love it. Good job and thanks for follow up.

Try and Fail rather than Fail to Try : Dentistry is full of experts who've a fixation on extracting roots and banging in implants when there are several paths...in my own case , I have had post core and pfm crowns for over 35 years. Who writes all this failure in 3 years stuff? DOK is right . Mind you, the post looks pretty short in the xray : assuming the crown is bonded rather than cemented, could be fine...

Thank you for the follow up Tim. For those who did not see the original discussion, I would encourage you to review the first post. Tim opened up a great discussion on whether to save a tooth or not. The opinions were respectful but diverse and contrary. It was a great discussion. This follow up proves to some degree what was being said by the restorative dentists. The tooth was not doomed to certain failure. Certainly a longer success duration for this tooth needs to be shown before any meaningful longevity claims can be made; but at least to some degree, those who advocated restoring the tooth have been shown not to be completely wrong. Hopefully this case will prompt those recommending the tooth be replaced with an implant to at least consider a restorative option in future rather than a surgical one. The other point of interest is the width and size of the post. In the original post I mentioned that I normally placed a post approximately 50% of the root length and I remove minimal tooth/root structure when preparing for the width of the post. Nevertheless I would consider the post size in this particular case to be shorter and narrower than desirable. I acknowledge this depends on many factors and it is operator choice. However, the point I am making is that even with the post being minimal, and with several other writers previously saying there was not enough tooth/root structure, this crown has survived 3 years and I suspect many more. So I would urge all readers to be open to saving teeth and not be confined to prescribed ideas about posts, root length or the brittleness of endo treated teeth. These issues are real but each case needs to be considered on its merits and the restoration engineered and designed according to circumstance.

As a periodontist, I like saving natural teeth and crown lengthening is an important component. Also, treating vertical osseous defects wit GTR is also something that is underutilized.

Well done

You cannot beat nature's own. In my humble opinion this should always be a treatment option , particularly for this age group and the obvious periodontal health. I think it is tantamount to negligence to remove such a tooth and replace with an implant although there are plenty who would do this . It is one of those cases where you must ask 'what would I have here?'- I know few dentists who would undergo an extraction in such a case! My case rests.

A good long strait root with no perio is nature's best implant in my opinion. My rule for restoring this situation with a post is: 1) the post must extend into the root at least 2/3 the distance between the top of the exposed root and the restored incisal edge of the crown. 2) the post for a single rooted tooth must have a flange to resist tipping forces. 3) the post must be bonded with resin cement. 4) There must be 1mm ferrule for crown margin all around the root beyond flange not encroaching BW. I prefer a #1 SS Flexi-Flange for this particular case. This root also would have been a good candidate for Partial Extraction Therapy instead of crown lengthening IF the gingival margins of both central incisors were at same level.

Great job , you manged to save the tooth at least so far. Why is no one saying anything about the fact that this person dentition is collapsing. and has obviously not gotten the care they need over the years. I'm 72 and if my teeth were in the shape of this person I hope my dentist would at least give me the option to restore my bite to a more stable situation. What tooth is going to break next? Where were the dentists in this persons past that would have predicted this is going to happen? Do you think they are too old to worry about it? How about when they get older and can't get around so well and more teeth are breaking. Its amazing how everyone is focused on one tooth and not mentioning the big picture.

So far so good! Thanks for sharing the update. As others have mentioned, a longer post would be nice. Hard to believe that tooth doesn't have an interference in protrusive, but you would have known that in much less than 33 mos.

When dealing with extract/implant vs saving a tooth patient’s always ask what is a permanent solution. I tell them an implant is as permanent as the tooth it replaces.

I like Mark Simpsons thinking! Also Gordon Christensen recommends placing a titanium pin into palatial along with the post. Correcting overclosure and restoring the occlusion can go a long way to preserving your excellent work restoring the tooth. The biggest problem I see with posts is a vertical fracture and the the implant option needs to be offered.

Nice Job! Nice Result!