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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 didn’t try. I squirted the distal after thinking I wouldn’t 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 don’t do it justice. In this case, the axial views ( which are generally some of the most helpful for identifying canal position in normal cases) didn’t 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)
