The Age Old Question of Endo vs. Implant?

This 20 year old female presents after having been in inconsistent ortho treatment for a few years in another country. Many of her roots appears blunted. She presents with the following radiographic and clinical presentation of #19. The Endodontist gives at most a 70% chance of success with RCT. What would you advise this patient at this point? And for those who would recommend extraction, would you perform site preservation at the time of extraction?

The Age Old Question of Endo vs. Implant? 1

ajaykashi comments:

From the presented radiograph endodontic therapy in this specific case might be a losing battle in the long-term. I would lean more toward extraction and socket preservation/graft to prepare the site for an implant. Caveat.....I am not sure if ortho treatment is still in progress or if it has been completed. If she is currently still undergoing ortho treatment, I would wait until ortho treatment is completed first before considering implant therapy. However, extraction and grafting right away might benefit toward creating adequate room for tooth movement via ortho at this time (i.e., presuming she is undergoing ortho treatment at this time) and prepare the site for implant in the future. Implant placement must only be considered once all ortho treatment and any other pending restorative work is completed and the final tooth positions are established and finalized. Great discussion case and glad to contribute. Good luck. Ajay Kashi, DDS, PhD

andy-k comments:

It’s a simple Perio Endo lesion. Give it a try for Perio first, most likely need to adjust the occlusion. If it doesn’t work, you can do extraction, bone graft & implant at any time. Patient is still young, most likely she will response to Endo treatment well. I always ask myself, if it is my tooth, what will I choose to do…

mccavity comments:

With those long standing draining sinus lesions resulting in buccal plate compromise and possible a contributing factor to implant placement post removal, advise options : If Endo successful and pathology reverts treat restoratively- if pathology persists, could be fracture, perio etc then remove, augment and once area ready to implant. At 20 I’d rather retain as much as my own genetic tissue. Let us know progress please. Much appreciated

timcarter comments:

I think the endodontist is extremely humble and should give him/herself some credit. I would have this treated and wait for resolution prior to restoration. In the event that extraction/implant is needed I would simply extract-wait 6 weeks- place implant. Due to the height of the M/D bone I would not anticipate a graft being necessary though many folks would opt to place one.