In Part 1 of this series, I asked if you would treat #14 or extract it. We saw both sides of the fence in this discussion. As usual, there are many different factors to be considered prior to making a decision. Of course, because I like to observe the way the dental community thinks, I didn't provide all of the information. The questions that might be asked are:

  1. What did the tooth look like in previous radiographic exams?
  2. What is the long-term prognosis of a Grade 2 furcation involvement?
  3. What is the restorative plan for the upper arch? Where do the teeth go? Does this bridge factor into that treatment plan?
  4. What does the patient want long term?

Our patient wants more than anything to have her mouth at a place where she, "can stop worrying about it every time I go to the dentist." She would like stability instead of issues every year or two.

The furcation is progressing. In films from 2011 there was no radiographic evidence of intraradicular bone loss although we have no periodontal charting from that exam. She has 9mm of total attachment loss on the facial of that tooth and no attached gingiva on the facial. There is endodontic involvement. This patient has a severely restricted occlusion or pathway issues. In order to give her more overjet she either needs ortho or to have her VDO opened to accommodate increased overjet.

Our decision was to extract the tooth. We are restoring the entire upper arch and while the molar could be treated with an endo, perhaps some Emdogain® to stimulate bone growth in the furcation and a new restoration, the patient did not want to take the risk of that therapy failing.

Ultimately, she will have implants in the 13 and 14 position.


Commenter's Profile Image Ramin Azghandi
November 21st, 2013
Steve, I think the statement “stop worrying about it every time I go to the dentist” says it all about why only a definitive treatment was indicated. If the furcation invasion was progressive and there was no attached gingiva on the B aspect there is no way we can honor her wish and assure her everything will be alright at each recall unless the culprit is removed and replaced. I would have recommended the same to the patient as well as to her referering doc. Ramin