Dentaltown August 2018 - 98
Fig. 19
Fig. 20
Fig. 22
Fig. 21
Fig. 23
The root canals were completed over multiple
visits until the teeth became asymptomatic.
We were able to recall the patient at
six months (Figs. 19-22) and two years
(Figs. 23-26) after the procedure. The images
show the PA, axial view, sagittal view and
coronal view, respectively in each time frame.
Remember: If we can detect disease a
lot quicker with the cone beam, the opposite
will be true when we are evaluating the same
tooth with respect to healing. It will take a
lot longer for you to see the bone healing, but
it doesn't mean it's not happening.
Fig. 24
Fig. 25
98
AUGUST 2018 // dentaltown.com
and, upon radiographic examination, I
discovered she had a very large periapical
radiolucency that encompassed teeth
#23-26.
I found no response to cold in teeth
#23-26, percussion tenderness only to
#25, and no mobility of the teeth. She
was diagnosed with necrotic pulps in teeth
#23-26 and acute apical abscess. My initial
treatment was to open tooth #25 for an
emergency pulpal debridement, but to also
perform root canal therapy on #23, 24 and
26. I obtained a cone beam-not to see the
lesion, but rather to get an appreciation for
the true extent of the bone loss (Figs. 16-18,
p. 97: sagittal, axial and coronal views,
respectively).
The coronal (Fig. 18) is the view that really
puts this case into perspective: This young
woman had only a sliver of lingual bone left.
Getting her bone back was critical, so
she was treatment-planned for root canals in
teeth #23-26. This was based on her pulpal
diagnosis of all the teeth, and done just in
case surgical intervention was in her future.
It helps locate
hard-to-find canals,
especially the MB2
in maxillary molars.
To this day, even though I have 10 years
of extensive endodontic experience, some
canals can be hard to find. The MB2 canal
in particular can still be a challenge to
locate, but it's present in the maxillary first
molar about 95 percent of the time. When
I don't fi nd one with the microscope, my
cone beam always saves the day.
Fig. 27 is a case where a cone beam served
multiple purposes. I initially took the cone
beam to assist in my diagnosis, then returned
to it later to confirm whether there was an
MB2. My patient was experiencing very
vague pain, and we could not reproduce the
sensation with traditional testing. Since the
periapical radiograph (Fig. 27) showed the
teeth to be within normal limits, we took a
cone beam.
The cone beam (Fig. 28) showed that
there was some thickening of the sinus
membrane (green arrows) and also the smallest
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