Kase of the Month

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A good PA radiograph is the first line of offense when diagnosing cause of failure for the obvious reasons. But many times more importantly, a CBCT is much more diagnostic. The third dimension shows missed anatomy, gross fractures and/or fracture bone loss patterns. It shows radiolucencies that may not have shown up on a 2D Image. For myself, I take a scan on every re-treatment. I want as much information in front of me before I start. It's the navigation before a trip.

This patient presented with tooth # 28 mobile and fistulated. It had a prior RCT and a post/core/crown restoration. There was a fair amount of bone loss apically and towards #27 which on pulp test reacted completely vital. CBCT indicated a missed lingual canal. Rather then dismantle and completely retreat or even worse decide to extract, with the patients INFORMED CONSENT I attempted to channel into the tooth on the lingual side of the tooth and locate and clean the missed lingual canal. Using the microscope after 2 visits I was able to negotiate the lingual canal, leaving the buccal canal and post intact. By the time the patient returned for his final visit the fistula resolved and the tooth was only slightly mobile. The case was obturated and the access was closed with composite hence saving the patient the cost of a new post/core and crown.

So it is important to have the proper information at hand before you decide to re-treat and not make assumptions that result in alternatives that may be unnecessary.

See you next month.

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Figure 1