I agree with Dean Hutto on principle.
BTW, that "follicle" on #17 isn't a follicle. It's by definition a cyst. The cystic space is > 2mm from the coronal tooth structure which means a cyst should be assumed here. You've at least got to biopsy the "cyst" lining to confirm diagnosis.
I'd be checking a CT before making any decision about either of these for sure. The surgeon and the patient need to understand risk vs. benefit before making a decision. Since the cyst would most likely be a dentigerous cyst, and since there ARE documented cases of dentigerous cysts transmogrifying into ameloblastomas, I would think you'd want it out of there. However, IF the nerve canal IS intimately associated with the roots of that left wizzie, risk versus benefit might suggest biopsy only and leave it alone otherwise and take your chances on no transmogrification. Odds of that ARE low, but still exist. CT plays a big role in determining risk. There IS benefit for removal. The question is: Is that benefit outweighed by risk of permanent hypoesthesia/anesthesia and/or rupture of mandibular vessel(s). If you were to leave that wizzie, you would need to document that the patient is taking the responsibility for that decision and have the patient sign something saying so. If it is not taken, routine PANX will be necessary to assess for gowth of the cyst and/or signs of transformation.
I don't think John's suggestion will work for the patient's left molar, because there isn't anything stopping #17 from erupting. It's not like it's bumping into the 2nd molar and by cutting the crown off of the 3rd you free it up to erupt further. I would think it would work for #32 possibly. There IS a small possibility that #17 COULD be being prevented from further eruption by pressure within the "cyst." By biopsying the cyst lining and "popping" the cyst in the process, that removes that potential hindrance to eruption.
I'd at least biopsy #17 whether you take it or not. I agree that it is likely that removing it may be much easier with #18 gone. Same on the other side.
And NONE of this even takes into account the chronic infection that is likely to continue in pockets surrounding these teeth should they persist and the systemic effects of those infections.
Me, I'd want them out, but I wouldn't decide without a CT/CBCT.
On May 29, 2012, at 5:57 PM, John Wilson wrote:
Once when I encountered this I did a decoronation procedure on the 8's. This
entailed removing the crown and then suturing it back up and leaving it for
the 8 to erupt out past the canal. I only did it once and it worked.
John
Lake Dental Health Centre
John R Wilson
46 South Shore Rd, POBox 980
Lake Cowichan, BC, V0R 2G0
250.749.3233
-----Original Message-----
From: acesthetics@googlegroups.com [mailto:acesthetics@googlegroups.com] On
Behalf Of Raymond J. Voller, DMD
Sent: Tuesday, May 29, 2012 12:01 PM
To: ACEsthetics@googlegroups.com
Subject: [ACEsthetics] thirds leave, seconds sacrifice idea
Do you agree with this treatment I proposed to my oral surgeon, Dr. Chris
Martone? He doesn't want to take out the lower thirds and there are 9 mm
pockets behind the seconds.
Thoughts?
Ray
-----Original Message-----
From: Raymond J. Voller, DMD [mailto:drvoller@comcast.net]
Sent: Tuesday, May 29, 2012 2:58 PM
To: 'cmextract@aol.com'
Chris,
In order to leave #17 and 32 in there, I would HIGHLY recommend ext of 18
and 31. There are 9 mm pockets distal to these second molars and leaving
these teeth in there could really compromise her health over time, since
they communicate with the thirds. I'd like you to plan on implants for all
four of the lower molars.
Not sure about the longevity of the lower centrals but I think we could
restore them if she wanted. The other restorative work I could do while
we're waiting for the lower molars to heal and implant integration for their
replacement too.
She has a limited financial capability to get this all done, but I
definitely think that we need to sacrifice all four lower molars to get
those thirds 'incased' in bone. Removal of them I agree is problematic.
Ray
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