Implants · patient case question
A patient has an intraoral lesion at the junction of the hard and soft palate requiring removal. Which consideration governs the choice of surgical modality?
Patient case: Implants, spaces and a lost tooth
demo: 48-year-old male
chief: Wishes to replace a missing mandibular first molar with an implant.
history: Healthy non-smoker. He also has a Class II division 2 incisor relationship.
meds: None.
findings: CBCT shows 13 mm of bone height above the inferior alveolar canal at the proposed site. The mandibular arch shows a deep overbite. A separate panoramic film taken for a different patient is used to review counting of missing teeth.
Show answer and explanation
Correct answer: C. The need for an artefact-free specimen if histopathology is required
- A. Speed is a convenience, not a clinical justification for compromising a specimen.
- B. Patient preference is respected in genuinely equivalent options, but the diagnostic requirement takes priority.
- C. Correct. Where a diagnosis has not been established, thermal modalities such as electrosurgery and lasers coagulate the specimen margins and can render the histology uninterpretable. If the tissue must be examined, use a cold blade, or take an incisional biopsy first and only then use a thermal device for definitive removal.
- D. Cost matters to the practice but does not determine what is right for a given lesion.
Note: The recall recorded a choice between electrosurgery and an erbium laser with the author unsure. The examinable principle is that whichever is chosen, the histological requirement comes first, and electrosurgery is additionally contraindicated in patients with a cardiac pacemaker.