Restoration after perio treatment

[Dr M]

Hello there Colleagues,

I would just like some advice on a case I am currently treating. Patient was referred to a periodontist for chronic generalized periodontitis. He is an alcoholic and a smoker.
According to the patient, treatment was done and completed about 2 weeks ago by the relevant specialist. It sounds like it was only normal root-planing with a few extractions of teeth that had a poor prognosis. No report was sent by the specialist to indicate the treatment was completed, but the patient reported that he only had to go for regular cleanings at checkup visits.
He then said the periodontist advised that we crown the 6 anterior teeth, close the necks of the posterior teeth with class V fillings. The patient insisted that this be done ASAP, because he wants " a white smile ".
My question is this-what is a suitable waiting time after "completion" of periodontic treatment before starting prosthodontic rehabilitation?
The right lateral incisor has minor mobility with which I was not happy, and if crowns were to be done, I would prefer doing all 6 anterior teeth, simultaneously. I advised the patient to come back in 6 months, to see if there was any improvement, and plan to get a report from the specialist regarding the patients' treatment and if it was indeed "completed".
I know it is difficult to give an exact time frame since cases differ, but I am hesitant to do crowns on a patient with periodontitis, because I do not want to build a house if the foundation is not solid.
Is 6 months enough usually? Should I wait for the periodontist to give an official go ahead before I start? Would you advise doing crowns on a periodontally compromised patient at all?
Any advice or ideas welcome

 

[honestdoc]

I agree with you on needing solid foundation. What were his relevent probings? Tooth #7 has class 1 mobility? Is that due to poor crown to bone ratio? How is his occlusion? How is his compliance to home care and making to his appts? I live in an area where patients are quick to sue and someone of poor to questionable compliance may deter me from big cases.

 

[MattKW]

Yes, sounds a bit unlikely to me. I'd email the periodontist and get his info. I doubt a periodontist would "advise" a patient to get crowns and buccal restorations for aesthetics.
I would also be very wary of crowns because with more necks showing after perio treatment, then the longer and deeper crown preps might really weaken the teeth plus come close to pulps. What will be the eventual crown:root ratio? I would be more inclined to investigate possible composite additions so that you don't have to cut away good tooth structure.
Don't get bullied into risky treatment by pushy patients. As honestdoc says, if it fails (tooth snaps off, tooth devitalises), the patient will blame you and you'll need good reasons to defend your treatment plan.

 

[honestdoc]

A Dental Assistant told me a dentist she used to work for was bullied to do a cantilever bridge in the posterior (doomed to fail despite any best attempts). The pt later reported him to the licensing board and he was disciplined. I'm not sure if the pt filed for lawsuit. I have numerous pts bully me. About 5 yrs ago, I had this young lady with severely rampant caries like in a Meth mouth. She denied using any substances and was in constant intense pain. I could not keep up with her deterioration and all my work failed. She bullied me into doing crowns but I refused. She later sued me (naming my employer) for her teeth deterioration. I looked her up and found 2 meth related arrests, one of them during our time of tx. She initially filed for $995k and because of those of those arrests, dropped to a $35k settlement due to my poor record keeping. Afterwards, I learned to take better records.

 

[MattKW]

Ouch! And because of people like that and their attorneys, our indemnity insurance keeps increasing. Sometimes you get a bad feeling about patients and you have to make voluminous notes just in case.