CBCT and Microscope….necessary tools
Tyler Boss DDS
This case demonstrates how essential the microscope and CBCT are in everyday endodontic clinical practice.
The patient was referred and diagnosed with a necrotic pulp and an acute apical abscess. He was exquisitely sensitive to percussion and palpation. CBCT shows radiolucencies around all apices and extending into the furcal area. Careful manipulation of the slices, reveals a fourth root that contains a separate canal (MB2). This information provides confidence in rendering thorough treatment of all anatomy without unnecessary removal of tooth structure.
Treatment was provided in two appointments. During the first appointment, 3 canals were cleansed and shaped. Calcium hydroxide was used as an inter-appointment medicament. The patient returned asymptomatic for the second appointment. Deep troughing was necessary to reveal MB2. A microscope that magnifies and bathes the working field in light is absolutely necessary in order to locate a canal orifice that is located midway down a 28 mm canal.
A resin matrix was customized to allow placement of a bonded amalgam restoration which is subset and extends 2-3 mm into the canal orifi for retention. This type of permanent restoration conserves tooth structure by not requiring the removal of additional precious pericervical dentin in order to place retentive devices such as posts and pins. The restoration provides the retention necessary in a posterior molar tooth with minimal group function (ie. has anterior and canine guidance) with minimal lateral shear forces.
The case demonstrates that neither a CBCT nor a microscope alone are sufficient in providing the practitioner with the tools and information necessary to provide treatment that will last.
The patient was returned to the referring dentist completely asymptomatic and ready for the placement of a full coverage crown. The third molar’s angulation was creating a food trap interproximally causing a periodontal defect. It was recommend for extraction.