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The opinions within this web page are not ours. Authors have been credited
for the individual posts and photographs where they are. - www.rxroots.com

Buccal gingival swelling and draining sinus

From: Rob Kaufmann
To: ROOTS
Sent: Thursday, May 27, 2010 8:10 AM
Subject: [roots] Twisted Sister!

A retired RD ( one of the few who had actually taken courses with 
Herb Schilder at BU and  years ago took time off from his practice to  
watch me work)  sent his wife for treatment. Necrotic case,
buccal gingival swelling and draining sinus . Mandibular Third molar .

Crown came off after access ( NO retention at all!) 2 weeks of  Ca(OH)2  
and we finally finished it today. Lots of hand files but did manage to 
get some rotary Ni-Tis around the mesial canal curves.  Distal canal
didnít try.  I squirted the distal after thinking I wouldnít be able to 
get a decent cone fit,  Mesials were done with conventional cones and 
warm GP.   That was one curvy mother!

I also enclose some cbCT images that I used to try to define the 3D 
extent of the  curvatures  both M-D and Bu-L I apologize for the cbCT  
not distal enough (staff!)   - but you can see the curves at the right 
edge of the scan. I manipulated  the Oblique slice feature to get the 
best view of the root curvatures in a M-D direction. The enclosed .jpgs 
are  a couple of stills where you can see that the M root and D root 
are in different planes Bu-Lingually. ( The M root is buccal to the 
D root position)  You really do need to work the images back
and forth to appreciate the 3 Dimensionality of the cbCT. The screen 
captures  donít do it justice. In this case, the axial views ( which are 
generally some of  the most helpful for identifying canal position
in normal cases) didnít really assist me that much the roots were too 
curved.

You really do have to play with these images to get the info you want 
- Rob Kaufmann DMD MS(Endo)

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