When is a tooth not restorable?

[meisterluv]

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I have been looking for ADA guidelines on this topic but can only find a UK index. What is the general consensus on when a tooth is not restorable?

 

[ZestyToothpaste]

I have been looking for ADA guidelines on this topic but can only find a UK index. What is the general consensus on when a tooth is not restorable?

there's no consensus in the dental community and every situation is different. dentist has to factor in his/her skills, clinical presentation, patient motivation, occlusion, etc..

 

[321931]

You learn that alot in dental school is considered "ideal" treatment. You go out into the real world and see a variety of cases that shouldn't work- but do work. I have routinely restored with success and seen my predecessor restore teeth that are deemed borderline hopeless on older patients with success. Fixing a tooth on an 85 year old for a few years is better then removing it and saying "hey you need implant/crown." They maybe on medicaid/fixed income/can't afford a 5000 implant/crown and may not live to see tomorrow. Noone will fault you on that. Of course, you give them all the options and present implant/crown as best treatment and let them decide.

So yes, every situation is different, and as such- you have to really evaluate each situation carefully. Obviously cracked teeth that are vertical root fractures and abscessed teeth cannot be fixed without extraction/rct.

 

[endough]

Tooth restorability depends on many factors and it’s important to look at several considerations before making a decision whether to save or extract. How’s the occlusion? What’s the status of the coronal tooth structure? How stable is the periodontium? What’s the caries risk of the patient? Are there neighboring teeth? What’s the function of the tooth in question? What are the patient’s motivations? Is there localized pathology present involving pain or infection? Is there any significant and relevant medical history? What’s the long term prognosis? Would the site be better suited for an implant? What is your skill level as a dentist? What’s the patient’s financial situation? Etc.

 

[2TH MVR]

Based on a lot of these replies. It appears that the phrase "evidence based dentistry" is difficult to practice in the REAL world. And as a result .... Brings about patient 2nd,3rd opinions. Then the last dentist to see the patient will predictably roll their eyes after hearing what the other opinions were.

 

[meisterluv]

Based on a lot of these replies. It appears that the phrase "evidence based dentistry" is difficult to practice in the REAL world. And as a result .... Brings about patient 2nd,3rd opinions. Then the last dentist to see the patient will predictably roll their eyes after hearing what the other opinions were.

Yes. It is surprising that the ADA doesn't have any guidelines to help streamline decision making and prevent confusing Pt.'s with conflicting opinions.

 

[321931]

Yes. It is surprising that the ADA doesn't have any guidelines to help streamline decision making and prevent confusing Pt.'s with conflicting opinions.

When it comes to new patients, I always steamline it towards ideal treatment. When it comes to existing patients that have been coming for years, I will go out of my way to do heroic treatments. Heroic treatments work sometimes, but sometimes, it doesn't work- then they might go get a second opinion, some other doctor says "huh why would a doctor ever do that" and throw you under the bus resulting in sleepless nights.

My last heroic case was placing MTA 3-4 mm subg on a rct #8 lingual and placing a large composite over the top. The only other option is extraction and implants. Shes 91. I bet the MTA patch will outlive her.