Jon Richards DDS MS
Often times the diagnosis of oral pathologies is an art as much as it is a science. The clinician has a finite number of instruments and tests to aid in the diagnosis and is left to fill in the blanks with anecdotal or empirical reasoning. Experience and solid inductive thought processes are imperative in the methodology, but sometimes leave the practitioner grasping for more information in his quest to provide an accurate diagnois, which is obviously compulsory in order to provide adequate treatment.
The CBCT can be instrumental in providing an accurate three dimensional image from which precious data can be extracted during the diagnosis process. This case superbly demonstrates the value of it’s clinical use, resulting in a different treatment plan than might have been chosen without it.
The patient was referred for treatment of teeth 30 and 31 due to symptomatic irreversible pulpitis. Prior to initiating treatment on 31 a CBCT was taken in order to provide more information reguarding the positional relationship between the third molar and 31. The 2-dimensional periapical radiograph shows that they are in close proximity, but we are unable to tell how much overlapping of the two teeth occurs nor their spacial relationship. The CBCT establishes that the third molar has encroached on the distal root of 31 and caused substantial resorption of the root surface. There is a thin shell of dentin between the third molar and the canal space. This finding can potentially complicate or even preclude the successful endodontic treatment of 31. It allows the practitioner to alter the treatment. Instead of proceeding with the root canal treatment of 31, the patient was referred for extraction of the third molar. Because of the hight risk that the pre-operative prognosis of 31 will change following the extraction of the third molar, the patient is appointed for a reevaluation following the extraction.
This case demosntrates how the CBCT is essential in precise and accurate diagnosis, which is the hallmark of a conditioned and skilled clinician.