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The opinions within this web page are not ours. Authors have been credited
for the individual posts where they are. Photos courtesy Rob Kaufmann - ROOTS
  Occasional palatal swelling: Resorption mapping

From: Rob Kaufmann
Sent: Tuesday, June 23, 2009 5:40 PM
To: ROOTS
Subject: [roots] 1st cbCT case

Here's the first one we did with our new Kodak 9000. We installed on 
Thursday the 11th and it just so happened that this patient walked in 
that morning. We offered her a free cbCT ( supervised by the Kodak rep) 
as a test case.

49 year old female in good health had a history of occasional palatal 
swelling at the gingival margin of the maxillary left central incisor.  
She had previous Ortho treatment as you can tell by the blunting of 
the apices. Although she was not in any acute discomfort, there was 
some doubt as to whether an exploratory Palatal flap was worth the 
effort. I consulted with the Periodontists in the building ( who were 
kind enough to locate teh cbCT in their office ) and they were also 
insterested to see what it would show.

The scan showed that the palatal ECIR was larger than we had anticipated 
and that it was not worth flapping the case to try to determine the 
extent of the resorption. The patient was scheduled for implant 
treatment plan to include extraction and replacement by my periodontist 
friend. The use of the cbCT had one added bonus - by NOT flapping the 
palatal area in between the 2 centrals we preserve the papilla for 
optimal implnat aesthetics. IN teh past, we may have done the exploratory 
surgery and lost this important soft tissue aethetics. So, by
(normally) charging the patient a few hundred dollars for the scan we:

(1) get a much better assessment of the area
(2) avoid costly surgical procedures
(3) preserve important soft tissue anatomy in the aesthetic zone
(4) Steer the patient in teh direction of  a treatment that has less 
    guesswork, higher predictability and that works....the first time.

Still working on getting report formats/images in teh proper places so 
please excuse the mish mash of images.

I can see me now ROUTINELY  charging the patient another couple hundred 
bucks in the diagnosis/exam of retreatment cases with LEOs. I will tell 
them that if tehy want me to dissassemble/reTx - I gotta know what I'm 
getting into.... THIS is the best way to know that.

The Kodak 9000 is one VERY cool machine. I can see me using more and 
more...even though I DON'T do implants

Rob Kaufmann DMD MS(Endo)

palatal swelling

palatal swelling

palatal swelling

palatal swelling Awesome!! - Fred Rob, I'm jealous, we don't have one of those yet, I still order CBCT take out burgers. ...very handy for resorption mapping - Terry Rob,Will you really be able to see initial VRF or extension of Craks vs Split tooth even under cronws, with CBCT? Will you be able to see 3 MM missed canal or other aberrant ones, with CBCT? What about extensive decay under former-long bridges that are not evident under clinical or convetional X-ray examination? You will be able to predict restorability of those teeth previous dissasembly, with CBCT? If those are the cases, send cases as soon as you diagnose those ones please. How much do you calculate you should charge for CBCT? How much do you use to charge for dissasembly complex cases: crown, bu, posts, fractured files, ...? - Nuria Campo Will you really be able to see inicial VRF or extension of Craks vs Split tooth even under cronws, with CBCT? I'm not sure about that. We'll try a few test cases to see what happens. The crowns may cause some beam scatter that may affect our ability to see that level of detail. Perhaps some of the others that have cbCTs will be able to answer that question now. Will you be able to see 3 MM missed canal or other aberrant ones, with CBCT? I think that aberrant and missed canals should be visible with this technology. Since we know that " you need pulp to form roots" - closely examining the cross sections of the root can often give us a hint as to where these canals "should be". What about extensive decay under former-long bridges that are not evident under clinical or convetional X-ray examination? You will be able to predict restorability of those teeth previous dissasembly, with CBCT? I don't think that the scans have that level of resolution ( yet). Again, you may get "hints" but they do not yet replace conventional films for those applications, in my opinion. If those are the cases, send cases as soon as you diagnose those ones please. How much do you calculate you should charge for CBCT? We will be having discussions with my cbCT buying partners on Friday. I think we will be charging the equivalent of around $200 US for the cases I do. We will offer this service to other dentists in the city but WITHOUT interpretation - dentists will have to read their own images. How much do you use to charge for dissasembly complex cases: crown, bu, posts, fractured files, ...? In the area where I live,we have a specific fee guide that most endodontists use. There are different fees for many aspects of the case, crown removal, post removal, retreatment, number of canals etc - Rob Rob is spot on. Vrf is identifiable, but if metal restorative is in the neighborhood, scatter can make it impossible to find. Interesting cost point decision rob. I recently dropped our fee to 200 u.s. from 350, more affordable to the patient and frankly we make it up in volume. We do not charge for followup scans or post implant scans, just for diagnostics. This is really cool to me that we now have world class practitioners using 3d imaging. Iíve been fighting the fight for 5 years, usually getting dumb ass responses like ďIíve been working without it since wwII, I donít need it now,Ē etc. the more folks utilize the technology, the more uses, the more incentive to move ahead with r and d on the part of the manufacturers, etc. damn, I wish I was 20 something again. Iíll be retired or dead before we see all that technology is going to give us - gary

K 3 lightspeed

Crown replacement

Root reinforcement

Vertical root fracture

Periodontal pocket

Cox crapification

Cold sensitivity

Buccal sinus

Nikon 995

Distal canals

Second mesial canal

Narrow escape

Membrane

Severe curvatures

Unusual resorption

Huge pulpstone

Molar access

Perforation repair

Maxillary molars

Protaper shaping

Pulsing pain

Apical periodontitis

Mesial middle

Isthmus protocol

Fragment beyond apex

Apical trifurcation

Jammed K file

Mesial canals

Irreversible pulpitis

Bicuspid abscess

Sideways molar

Red Dye allergy

Small mirrors

Calcified molar

Extraction and implants

Calcificated central

Internal resorption

Bone lucency

Porcelain inlay

Bone allograft