Orthodontic or implant?

[Escanor]

I already extracted the 46 tooth wich was corono-radicularly fractured .Can orthodontic treatment offer a more consrvative result than implant to relace the tooth?

 

[honestdoc]

I'm not familiar with tooth "46." Is it the lower right molar 3rd from the back (tooth #30 in the US)?

 

[Escanor]

It's the mandibular right first molar

 

[MattKW]

No, it would be very difficult to move 47 and 48 forward into a good position. Upright teeth in the correct position will occlude better with the corresponding tooth in the opposing arch. I would suggest you remove 48 soon to prevent tipping of the 47 into the 46 space, and save up for an implant to replace 46. And get rid of the 38 wisdom ASAP.

 

[Escanor]

The 38 to decide which technique to follow for extracting it : can I just cut the coronal portion and try to luxate it upward without root separation, noting that the patient can not open his mouth wide (almost 4 mm or less), the surgically extraction of the 46 wasn't really so comfortable ?

 

[honestdoc]

The 38 to decide which technique to follow for extracting it : can I just cut the coronal portion and try to luxate it upward without root separation, noting that the patient can not open his mouth wide (almost 4 mm or less), the surgically extraction of the 46 wasn't really so comfortable ?

You can cut a thin Mesial coronal portion to fit an elevator and remove distal bone. You should get good movement when you try to elevate.

 

[MattKW]

You did very well if the patient is that limited. I've just realised you must be a dentist too.
Maybe the patient might need at least an IV and poss a GA with an oral surgeon for the 38 and 48 with that limited opening. And looks like a scap of 28 still present.
Don't start something you can't be sure of finishing.
If the patient could open properly, I would decoronate the crown of 38, then split the roots, and elevate separately (distal root 1st, then mesial roots would be easier to follow).

 

[honestdoc]

28 will be very difficult to access especially if the patient can not open wide. If you can get access and some leverage mesial to 28, it should come out. I like curved elevators and maybe East/West (not sure if those are available in Tunisia).

 

[Escanor]

Honestly you're right, all my carieer in hier I saw the most difficult upper extractions of the upper third molars were done with straight elevators.Actually I did. I'm trying to find the warwick James Elevator for a change, till now i wasn't lucky with the right provider.

 

[honestdoc]

Honestly you're right, all my carieer in hier I saw the most difficult upper extractions of the upper third molars were done with straight elevators.Actually I did. I'm trying to find the warwick James Elevator for a change, till now i wasn't lucky with the right provider.

I'm impressed. You are a very good dentist. You are able to work on difficult cases with minimal equipment. I'm spoiled here in the US with plentiful supplies.

 

[Escanor]

I think its the will, to have a greater result every time, equipment are necessary, it makes you feel full but not really able.