Periodontics · patient case question
What is the best treatment for this tooth?
Patient case: Fixed bridge abutment with 9 mm vertical bone loss
Scenario: A patient with a FIXED BRIDGE from the upper second premolar to the second molar. The abutment has had endodontic treatment but has a VERTICAL BONE LOSS OF 9 mm on the MESIAL side.
Show answer and explanation
Correct answer: C. Extraction
- A. The problem is PERIODONTAL, not endodontic. Retreatment does not address 9 mm of vertical bone loss. (A combined endo-perio lesion should still be considered, but the prognosis remains poor.)
- B. Monitoring an abutment with this degree of attachment loss risks acute abscess and loss of the adjacent abutment as well.
- C. Correct. A 9 mm VERTICAL bone defect on an endodontically treated bridge abutment represents advanced attachment loss with a HOPELESS prognosis. Retaining a hopeless abutment jeopardises the entire prosthesis and the adjacent teeth, so extraction and a revised prosthetic plan is the appropriate decision.
- D. Regenerative therapy is most predictable in narrow 2- and 3-walled intrabony defects with adequate remaining support. A 9 mm defect on a bridge abutment already carrying occlusal load has a poor regenerative prognosis.
Note: Practical point: after extraction, reassess whether the remaining abutment can support a cantilever, whether an implant is feasible, or whether a removable design is needed.