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  • 1. THE ENDODONTIC IMPLANT ALGORITHMMonday, February 9, 2009
  • 2. • Chief complaint • Dental history • Medical history • Head and neck exam • Intraoral exam • Radiographic exam • Clinical testing • Perio probing • Differential diagnosis • Treatment plan • Patient discussion • Team discussion TOTALITY OF TREATMENT PLANNING THE ENDODONTIC IMPLANT ALGORITHM: UNTYING THE GORDIAN KNOT © T. Pannkuk, K. SerotaMonday, February 9, 2009
  • 3. ACCESS Restorability: parameters for determination • radiographic assessment • design occlusal entry • extension - peel away pulp chamber ceiling • identify primary orifices • trough grooves • identify accessory orifices • orifice lengthening and widening • straight line glide path to apical third • no frictional file impediment along axial walls • discovery of deep anatomy • no unnecessary dentin removal • safe angulation- orientation avoids furcal aspect of root THE ENDODONTIC IMPLANT ALGORITHM: UNTYING THE GORDIAN KNOT © T. Pannkuk, K. SerotaMonday, February 9, 2009
  • 4. ROOT FRACTURE Clinical tests Perio defect? Fracture externally visible? Radiography Exploratory access, remove crown if necessary Extraction/Implant Tipping Point 1 Ca(OH)2 interim therapy, for 1 to 2 months Tipping Point II Obturate, restore transitionally, reassess Tipping Point III THE ENDODONTIC IMPLANT ALGORITHM: UNTYING THE GORDIAN KNOT © T. Pannkuk, K. SerotaMonday, February 9, 2009
  • 5. APICAL PERFORATION OR TEAR Is a split Does crown need to Perio defect? Radiography evident? be replaced? Exploratory access, remove crown if necessary Tipping Point 1 Extraction/Implant Ca(OH)2 interim therapy, for 1 to 2 months Tipping Point II Obturate, restore transitionally, reassess Tipping Point III Endodontic surgery Tipping Point IV THE ENDODONTIC IMPLANT ALGORITHM: UNTYING THE GORDIAN KNOT © T. Pannkuk, K. SerotaMonday, February 9, 2009
  • 6. SURGICAL RETREATMENT WITH POST Is a split Does crown need to Perio defect? Radiography evident? be replaced? Exploratory access, Is the post remove crown if necessary loose? Tipping Point 1 Extraction/Implant Ca(OH)2 interim therapy, for 1 to 2 months Tipping Point II Obturate, restore transitionally, reassess Tipping Point III Endodontic surgery Tipping Point IV THE ENDODONTIC IMPLANT ALGORITHM: UNTYING THE GORDIAN KNOT © T. Pannkuk, K. SerotaMonday, February 9, 2009
  • 7. EXTERNAL OR INTERNAL CERVICAL RESORPTION Is the resorption What type of Perio defect? Radiography surgically accessible resorption? cbCT mapping Tipping Point 1 Extraction/Implant Access, Heithersay technique, Ca(OH)2 for 1 month Tipping Point II Obturate, restore transitionally, reassess Tipping Point III Endodontic surgery Tipping Point IV THE ENDODONTIC IMPLANT ALGORITHM: UNTYING THE GORDIAN KNOT © T. Pannkuk, K. SerotaMonday, February 9, 2009
  • 8. EXTERNAL OR INTERNAL CERVICAL RESORPTION - COMPLEX Is the resorption What type of Perio defect? Radiography surgically accessible resorption? Tooth angulation cbCT mapping Extraction/Implant Tipping Point 1 Combined surgery, endo, resorption repair - MTA + Gerestore Tipping Point II Reassess Tipping Point III THE ENDODONTIC IMPLANT ALGORITHM: UNTYING THE GORDIAN KNOT © T. Pannkuk, K. SerotaMonday, February 9, 2009