Mohamed Salah k. Good point. Mobility testing in max molars is not as clear as anteriors but I would say this tooth did have about a +1-+2 mobility and +10 probing in the distal.

@@AANasseh I know it has bad prognosis but you Dr. Allen made us curious about every RcT case , my father and mother are dentists but you are the one who made me admire the Endodontics world.

I'm not sure about followed by implant. Implants have a questionable success in this area and if we add the existing bone loss it may also be an unpredictable option. I don't think leaving the area edentulous is necessarily a bad thing. The opposing tooth has contact with the first molar and the patient was already concerned about cost. So, maybe it's best to leave it as is. I told her to see if she finds the empty space disturbing and decide to replace or not afterwards. We'll see. Thanks for the feedback. :)

@@AANasseh I'd repeat the cbct 3 months after the extraction to see if the implant would be a viable option of course. Should've added an "if possible" after "followed by an implant" :) A sinus lift and a bone graft aren't out of question as well if the surgeon thinks that an implant is worth trying... But in the end if the patient makes up his mind that the missing tooth doesn't bother him and it's too expensive just the extraction will do :D

cgoudy88 First, thank you! Second, you’re absolutely right that the main factor here was patient motivation. I don’t like to convince patients of taking risks since I would be promoting the risk; and if it fails, would be responsible for my role in convincing them. So, I lay down the odds and guide them with what makes sense for them based on their values. Cheers!

That's a great point. I considered this approach but this patient was already thinking twice about saving this tooth (financial reasons) and since non-surgical endo would also require a surgical procedure plus core/crown and also the question of whether the perio defect there would heal considering how long it had been there I didn't think it's very predictable. So, when I gave her the options she elected extraction. But yeah... I think there's a chance it could have been saved. Thanks for the feedback! :) Cheers!

@@AANasseh great thinking and perfect planning for your patients

I haven't watched it yet. I don't want to watch it as every time someone watches it on Netflix it pushes it up the latter and I don't want to help promote that stupid movie! If I get a hold of a free copy I will watch it. I will certainly plan on sharing some thoughts on the topic, maybe with Dr. Koch or with other faculty from the school. It's an important topic and it has come up several times. Thanks for the comment. :)

@@AANasseh actually i found many videos recently attack root canal, as if its the reason for all body diseases... I cant imagine how to a precious disinfection therapy be a cause of disease...

Technically, every outcome is possible. The question is whether it's probable. Given the +10mm probing in the distal and the patient's lack of motivation I didn't go for it; but yes, if the patient was motivated in trying to save the tooth and was fully aware of the possibility of losing it despite the cost, then you can try and find out. Technically, no one really knows the future.

Thanks alot dr Allen , wish u come to Egypt again thanks alot for everything :)

Harshill Matta I agree. Unfortunately no one knows the future but it’s definitely a factor to consider and along with patient ‘s lack of motivation it tilted the balance towards extraction for me. Thanks for the feedback! :)

Most welcome Dr.

Some of those were excerpts for sending people to the website for the full video. I’m not doing that anymore. Decided to share 90% of all website videos for free. :)

Yeah. It's true. And I've done cases like this at no charge to the patient just to see what happens... I guess donating my time to learn is the way I look at it... but here, the problem was the investment that had to take place afterwards as well. It's a tough call to ask the patient to pay when you know the odds are questionable and the patient is otherwise not interested in taking a chance. You have a good point.

I think this is the best review.i don't have to use my head to think further . The cbct quite clearly shows all canals engulfed as radiolucent. Clinically HOW mobile was the tooth? Allen hasn't mentioned that point for us to think of taking a chance.

The mobility was about +1. Although it's hard to determine mobility in a maxillary second molar. The more important problem was the deep probing in the distal (+10mm).

Thank you..the extensive radiolucency involving furcation no doubt is a bad prognosis with added distal root hanging.I go with you totally.