Decision making

The Multidisciplinary approach

15 October 2020

Fitim Shabani

During our daily treatments we often face different situations where many disciplines of dentistry intertwine with each other, in some treatments we have the need for secondary treatments.

In this case what I am presenting to you as primary treatment is the endodontic treatment, while surgical and restorative treatments as secondary treatments.

The patient comes to our clinic with complaints in the lower right jaw, and to resolve this situation we performed a multidisciplinary approach to resolve the patient`s uncomfortable situation.

In this case the extraction of the lower right third molar was mandatory to enable distal marginal closure of the tooth.
As a start, we performed the endodontic treatment in one session, then the surgical removal of the third lower right molar was performed, and in the last session, the second lower premolar was restored.

Fig. 1

Clinical case 

Clinical data

Patient with pain in the lower right jaw.

There were many reasons:

  1. The third lower right molar was impacted
  2. The second lower molar – necrotic tooth
  3. The firs lower molar had aproximal decay
  4. The second lower premolar – distal deep decay
Fig. 2

Initial situation of the case

Fig. 3

Pre endo build up 


Root canal treatment in one visit

Fig. 4

X-ray after root canal treatment

Fig. 5

Surgical removal of lower right third molar

Fig. 6

Tooth separation

Fig. 7

Removing the tooth

Fig. 8

Distal build up with composit of tooth 47

Fig. 9

Completion of the surgical part

Fig. 10

Restoration of tooth 45 with composit 

Fig. 11


Fig. 12

Completion of multidisciplinary treatmentEndodontic treatment of lower right second molar surgical removing of tooth lower right third molar composit restoration of lower right second premolar

Fig. 13

Final x-ray 


Multidisciplinary approaches gives us full control of the various situations we have to deal with in our daily work, on the other hand these types of approaches make us more efficient and safer.

These situations need to be well plannned in advance and have a reasonable chronology.

Multidisciplinary approaches require knowledge and skills of the dentist, as well as cooperation from the patient, and when these conditions are met then success and long-term prognosis will not be lacking


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Chad M. Reader, DDS, Van T. Himel, DDS, Lisa P.Germain,DDS, and Michael M.Hoen, DDS

Effect of Three Obturation Techniques on the Filling of Lateral Canals and the Main Canal. Journal of Endodontics, August 1993

N.J.M. Opdam, F.H. van de Sande, E. Bronkhorst, M.S Cenci, P. Bottenberg, U. Pallesen, P. Gaengler, A. Lindberg, M.C.D.N.J.M. Huysmans and J.W van Dijken. Longevity of Posterior Composite Restorations: A Systematic Review and Meta-analysis, Journal of Dental Research 2014.

Jay W.Fridman, DDS, MPH. The Prophylactic Extraction of Third Molars: A Public Health Hazard. American Journal of Public Health 2007 Vol 97.

Gary F.Bouloux, MD, BDS, MDSc, FRACDS, FRACDS(OMS), Martin B. Steed, DDS, Vincent J. Perciaccante, DDS. Complicationss of Third Molar Surgery. Oral Maxillofacial Surg Clin N Am 19 ( 2007 ) 117 – 128.


About the author
Fitim Shabani
Fitim Shabani