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Case Study for Review

3D Cone Beam Image Scan

Our 3D Cone Beam Image scan has been operational since December 2009 and I’m most astounded at what it reveals and how much it helps the diagnostic process! Wow! I have included a case for review. It’s a failing root canal that I re-treated in December 2008. Healing had progressed but was incomplete. I took a scan to understand the root anatomy better and look for a possible split in the root. Before we go any further, look at image 1 with the 4 radiographs. The patient had no other symptoms, only the radiographic sign of a dark area around tooth #14. Take some time to study the 4 radiographs before looking at the second image.

Now look at image 2 with two different views of the tooth. When you go back to the original radiographs after you see the scan you can say there is a suggestion of a dark area around tooth #15 but it’s difficult to say that with certainty and also without nerve testing. We have found huge pathology that was so subtle on traditional radiographs that it was overlooked. Nerve testing and access confirmed a dead nerve. I can also see a damaged apex from surgical extraction of #16 years ago.

Now let’s focus on the root of tooth #14. Go to image 3 with 2 side views and one frontal view. The MB1 root looks good. I remember being a bit frustrated that I couldn’t get through the apex canal on the MB2 root. Now look at image 4 with the enlarged frontal view. Not only can we see that the MB2 canal takes a sharp 90o turn toward the palate, we can also see the canal (thin dark line) exit on the side of the root instead of the end of the root! Notice the largest diameter of the lesion is also centered over the canal exit. This view lets me know negotiation of the sharp bend in the canal would be unlikely making successful retreatment doubtful. I have a better chance of success with a surgery. I can also clean out the area between the MB1 canal & MB2 canal and seal it up better with a surgery.

In the future, I will highlight other cases including root fractures and maxillary sinus infections originating from maxillary posterior teeth. This is a great diagnostic tool.

Randall T Hedrick, DDS PLC

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