Learning from failure

Trying to save a tooth which is strictly in a bad condition is occasionally a mission for a dentist depending on a patient’s character, dentist’s skill, etc. It is sometimes difficult to make a decision whether the tooth can be saved or is hopeless and should be extracted.

This case was the molar tooth astride the bone defect, only the tips of three roots were hemmed in by remaining bone, which caused loosening a little. It seemed to be challenging to get complete bone fill in this case, because of complexity in shape at the site, which means difficulties of complete debridement before applying bone graft and Emdogain which is medicine for tissue regeneration. During 5 years, it had kept in a better condition after the surgery. However, bone loss and loosening happened in the end. The partial bone fill may be just a happenstance and temporally. In a challenging case, being craven should be avoided, however, eternity of the tooth was delusional as a result. If I encountered the same case, I would apply deferent incision lines and materials. Learning from failure must be kept in mind.

The photos are ,during surgery, X-ray before surgery, 1 year after, 3 years after, 5 years after, 6 years after, respectively.

Emdgain vs Regrowth?

Emdgain and Regrowth are materials for regeneration of tissues including bone around teeth for patients who have gum disease. Emdgain was developed in Sweden and has been used for a long time, which provided lots of good results. Regrowth was developed in Japan a few years ago, which means having short history, where top leading periodontists are accumulating clinical data in their own clinics. What I was concern was if Regrowth would be really effective in my patients’ cases. 2 patients applied only Regrowth were failure, no bone regeneration in X-ray after 6 months. 4 patients were successful by applying not only Regrowth but also bone graft. According to a recent web seminar and articles in a dental magazine,  some top periodontists are getting good results with Emdgain and connective tissue graft, without bone graft. Other dentists said gaining bone by Regrowth at first and gaining attachment by Emdgain in second surgery has possibilities to have more ideal results. The number of subjects is still small, so further information is necessary to get the truth. Selection of materials and techniques in each case are not well discussed. Pursuing latest information all the time and thinking may provide my patients happy results.