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.

Checking effects of tissue regeneration surgery

This is a case of periodontal treatment. A 60 years old female had chief complaints which were missing teeth and periodontal problems in remaining teeth, where original bone which hemmed in the teeth had disappeared because of gum disease bacteria. Implants placement for missing teeth and tissue regeneration surgery for the teeth which lost their surrounding bone were carried out. In order to check the results of the surgery, after 6 month, CT scanning was taken, which showed new bone regeneration to some extent, not perfect recovery.  Incision, debridement, and suturing techniques must be more improved to get better results. Material choice may be also important. Growth mindset has to keep in mind and fixed mindset should be avoided in my learning curve.

A CT horizontal section of the lower premolar whose surrounding bone was partially lost (right) a bird’s eye view of the site during the surgery (left)

Vertical sections (left) and horizontal sections (right) of CT, before (above) and 6 months later (below)

Photos during the surgery in the upper front tooth. Incision (above right), exposing defect (below left), applying Emdogain (below middle) , placing bone material (below left), suturing (above right) , 3D image before surgery (above middle)

before (left) and 6 month (right) after surgery, horizontal (above) and vertical (below) sections