FIND OUT WHY
Take a look at this radiograph. This is a four-year-old small breed dog. This is the right mandible and you can see that they are some significant and varying degrees of bone loss adjacent to those teeth. The question again, when do we extract or when do we treat? Looking at this radiograph, if you look at that last molar on the far left, that one has no bone surrounding those roots. That is definitely an extraction. That's not a particularly critical tooth by any means so, extracting that is definitely in the best interest of this patient. On the other hand, we’ve got a decision to make on that first molar. You see that we've got bone loss in the furcation and we've got bone loss extending to the bone between the fourth premolar and that first molar.
If you are presented with this next week, you have to take into consideration a couple of things. Number one is, if you cannot alter that and prevent the progression of it then that's going to be an extraction. That tooth on the left falls into that category. You can't alter that, you're not going to be able to save that tooth, is too far gone. This one, there's a possibility that you can and the way that we would do that would be to go in and open up an envelope flap there, expose that bone. Take our periodontal curette and scrape all of the granulation tissue out of those defects. If you open that tissue up, anytime you see a decrease in density in the bone like that, either in that furcation between those roots or between those teeth in that defect there, there is going to be granulation tissue in that defect. It's important to remember that because as long as that granulation tissue stays in there, that’s infected tissue that is full of gram-negative anaerobes that is releasing inflammatory mediators that are destroying the bone. If that granulation tissue remains, so does the disease process. At the very least we need to get that out of there and we do that with periodontal curette using our hand instrumentation to do so. Ideally we would also place a bone graft in both of those defects and the furcation bone there is very difficult to grow bone in. That being said, laying out the treatment regimen, once that's completed, once we clean that out, once we get the bone graft in there, we suture between the teeth and oppose that gingiva right up where it was previously and then the most important thing, before we even think about doing that is, we have to get the owners commitment to bringing that patient back every 3 to 6 months or everything that we've just done is not going to work. It's going to break down and it will progress if the owner can't get in in that regiment. If they can't do that for the rest of this patient's life, that is an extraction. That's kind of how we have to think about that in relation to the defects that we see. If we can't prevent progression, and many times that is when we’ve got severe disease like that second molar or we can't prevent the progression if we can't get that patient back every 3 to 6 months either. That owner needs to make that commitment or again that tooth needs to be extracted.
This is an actual 4 month or 3 months post-op on that patient. You can see we did get some really nice bone growth in the furcation. We've got some really nice bone growth in that defect. We cannot grow bone on top of bone or toward the crown in any defects so that is about as good as it gets right there guys. That's a very pleasing outcome in this patient.
Grossly when we have this patient back, here's what we have. This is the exact same patient, you see we've extracted at first molar. There's not a lot of change on the gum margin until we get to that area between the teeth there and that's where Titlewe’ve probed that tooth and we're getting bleeding. Why? because we got granulation tissue back in that defect.
Even though he's got the bone at the maximum level when we put our periodontal probe in there, we're going to get bleeding. That is why that patient has to come back every 3, 4, 5, 6 months in order for us to maintain and remove that granulation tissue that forms in the interim so that it doesn't have a chance to progress. This is a very good case, this is a very representative case of how we should be thinking about that in our patients on the individual