Extraction of lower canines

RE: Extraction of lower canines

Rob Davis — Fri, 28 Aug 2015 16:42:06 GMT

[quote user="Evelyn Barbour-Hill"]Long term fix. If healthy, why mess?. [/quote]

I'm glad you said that as that is what I had been thinking, but is not what I was taught!

RE: Extraction of lower canines

Evelyn Barbour-Hill — Fri, 28 Aug 2015 16:30:05 GMT

[quote user="Rob Davis"]On a slight tangent.... When you do crown shortening on an immature patient such as this hypothetical labradoodle, are you happy to leave the pulp capping as a long term fix, or do you advised to perform a full root canal once the root apex has closed?[/quote]

Long term fix. If healthy, why mess?.

RE: Extraction of lower canines

Rob Davis — Fri, 28 Aug 2015 15:26:35 GMT

[quote user="Evelyn Barbour-Hill"]I'd like to make more use of these osseoindunctive/osseoconductive material in periodontics – but the trouble is, none of this sort of periodontal surgery is going to work unless you can guarantee scrupulous oral hygiene afterwards. [/quote]

Indeed.... We were taught about guided tissue regeneration etc on one of the ESAVS courses I attended, but I was very skeptical at the time that I would ever have a patient whose owners would be diligent enough with their homecare to make it worth considering. I have not yet changed my mind!

On a slight tangent.... When you do crown shortening on an immature patient such as this hypothetical labradoodle, are you happy to leave the pulp capping as a long term fix, or do you advised to perform a full root canal once the root apex has closed? I was under the impression that pulp capping should be considered a temporary procedure, but it does significantly increase the cost if you need to have it back to do bilateral RCTs in a few months time.

RE: Extraction of lower canines

Evelyn Barbour-Hill — Fri, 28 Aug 2015 15:18:53 GMT

[quote user="Rob Davis"] I have wished I had some to fill defects left by dentigerous cysts on occasion, but they are very expensive products to keep on the shelf unless you are likely to use them regularly.[/quote]

I was considering doing that once – then I looked at the volume of the defect, and the volume of material in an unit of Consil........

I'd like to make more use of these osseoindunctive/osseoconductive material in periodontics – but the trouble is, none of this sort of periodontal surgery is going to work unless you can guarantee scrupulous oral hygiene afterwards.

RE: Extraction of lower canines

Rob Davis — Fri, 28 Aug 2015 14:59:33 GMT

Like Evelyn, I do not use anything to fill post-extraction, though I have considered it. I have seen case reports using either Consil (bio-glass) or bone chips (Osteoallograft periomix is designed for this purpose among others, but is horrifically expensive). I have wished I had some to fill defects left by dentigerous cysts on occasion, but they are very expensive products to keep on the shelf unless you are likely to use them regularly.

I believe that they are supposed to decrease the time it takes for the bone to fill in the void, although they do also appear to claim that they will increase the final alveolar ridge height, though whether or not this is cliniically significant may be debatable.

RE: Extraction of lower canines

Evelyn Barbour-Hill — Fri, 28 Aug 2015 14:12:10 GMT

[quote user="Gerry Henry"] given that removing these teeth would reduce the strength of the rostral mandible, does anyone use bone cement or another bone product to fill the hole and give some added stability.[/quote]

No.

What would be the point?

Bone cement or other bone products have no strength of their own to speak of.

The holes fill up with bone eventually.

Interesting engineering discussion though. What exactly is going to break, and under what stress, while the mandible is "weakened" by absence of canine teeth? And considering the mandibular structure as a whole, which is what counts, the structure is actually strengthened by absence of canine teeth since the leverage they can exert is removed.

I'm glad we're being hypothetical here, because: [quote user="Gerry Henry"]The client can't afford crown amp and capping and has elected to have the teeth extracted[/quote] that would be very very very silly. There's always orthodontic movement to consider, or if you are determined to do extraction at a charitably subsidised cost, why not do something much better at charitably subsidised cost?