Dentaltown August 2018 - 97

heal the tooth. Don't assume it's cracked
and send it for extraction; it might not be
cracked at all. So don't give up! As dentists,
saving teeth is our game.

It serves as a
communication and
patient education
tool, leading to
increased case
acceptance.
Sometimes I see patients who have
undergone an attempted root canal, but
because I have incomplete records or
information I use my cone beam to tell
me the whole tooth story. Th is takes the
guesswork out of the whole process and
shapes my conversation with the patient.
Fig.12 is a radiograph of a patient who
continued to have a sinus tract after she
had an attempt on her root canal. From
the radiograph, it looks like there was
a previous access of a tooth with a very
calcified canal. There is also the presence
of a periapical radiolucency, which is the
origin of the sinus tract.
Like an endo Sherlock Holmes, the
cone beam helped me reveal evidence of
what the previous clinician did. In this case,
the cone beam (Fig. 13) showed that there
is actually a canal, and I could be confident
when I access the tooth as long as I used the
composite as my buccal border. If I came
into contact with the composite, I'd have
known I was too far buccal and I ran the

Fig. 16

risk of perforating the tooth. Th is image
completely changed the conversation I had
with my patient, allowed me to de-emphasize
the possibility of surgery, and gave me
the confidence to try to save the tooth.
(Fig. 14 shows the completed root canal.

It helps determine
true lesion size and
assists in follow-up.

Fig. 13

The periapical radiolucency will always
be bigger in the CBCT than in the traditional PA, but don't let size scare you!
Otherwise you'll never save teeth once you
start working with the cone beam.
Fig. 15 is a radiograph of a 16-year-old
girl who had trauma to the mandibular
anterior region about nine years previously.
She presented with a very large swelling

Fig. 14

Fig. 15

Fig. 17

Fig. 18

dentaltown.com \\ AUGUST 2018

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