Dentaltown August 2018 - 96

Fig. 7

Fig. 8

Fig. 9

story of having a painful episode is usually
a sign that a nerve somewhere has died,
and it was through my cone beam that I
was able to diagnose appropriately.

It reveals the true
etiology of root
canal failure.
Fig. 10

Fig. 11

Fig. 12

but only tooth #2 (out of #2-5) had a
response to cold. I could not assume that
all of her teeth were necrotic.
I took a cone beam to see if I could
find any evidence of pathology and scrolled
through the entire volume of the cone beam
in every plane. Slice by slice, I looked for any
irregularities in the teeth and any resorption
of bone. The entire scan looked fi ne until
I got to the distobuccal and palatal roots
of tooth #3, where I could see a very small
radiolucency around these roots (shown
as yellow arrows in Figs. 2-4). The sinus
membrane was thickened around the area
(Fig. 4, green arrows) as well. Th is was a
sure sign that tooth #3 was necrotic and I
could be confident in my diagnosis, so my
patient didn't have to wait for the pain to
return before treatment.
Your patients will not always be the most
reliable testers, through no fault of their
own. Th is is an example of a patient case
where my cone beam helped me diagnose
disease when my traditional testing and
imaging are inconclusive. The patient's

96

AUGUST 2018 // dentaltown.com

When I see a root canal that is failing,
I always want to know why-and my
cone beam always tells me the whole story.
Fig. 5, p. 95, is an example of a patient with
a failed root canal on tooth #19.
The tooth has that typical J-shaped
radiolucency around the distal root, and
many would consider this tooth fractured.
But the axial slice of the CBCT (Fig. 6,
p. 95) shows the road map of the tooth and
you can clearly see a missed distolingual
canal. The missed canal is the true etiology
of failure. In reality, there's still bacteria in
the tooth, and the tooth is not fractured. In
Fig. 8, you see how the tooth should really
look when it's obturated.
The two cardinal rules of root canal
therapy were applied-finding all the canals
and getting to the end of every canal-and
two years later (Fig. 9 is a two-year recall
PA radiograph) the bone was fi lling back
in. This bone regeneration can also be seen
in the cone beam images (Fig. 10 and 11,
preoperative and two-year recall images side
by side to observe the bone regeneration).
The cone beam tells you exactly what
you need to find, with no more guessing.  Once you have a clear diagnosis,
you know exactly what to fi x and you can



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Table of Contents for the Digital Edition of Dentaltown August 2018

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Dentaltown August 2018 - No label
Dentaltown August 2018 - Cover1
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Dentaltown August 2018 - 1
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