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Endo tips    Better Endo    Endo abstracts    Endo discussions

CBCT Exam for patient slated for heart surgery - Courtesy ROOTS

The opinions and photographs within this web page are not ours. Authors have been
credited for the individual posts where they are -
From: Terry Pannkuk
Sent: Thursday, November 26, 2009 2:28 AM
Subject: [roots] CBCT Exam for patient slated for heart surgery

This patient was scheduled for open heart surgery (heart valve replacement) 
next week and his dentist and physician wanted clearance that this tooth 
did not have recurrent endo disease/infection. The patient presented with 
no observable symptoms and the PA was inconclusive.  The previous endo was 
obviously done poorly and one off-angle radiograph suggested a separated 
instrument at the tip of the DB.  I explained to the patient that I might 
be able to get more information from a CBCT that would help determine whether
the tooth should be treated before his surgery.  The value of the CBCT in 
this case was obvious and the patient elected to have me scan him.  
The previous endo treatment looks incompletely cleaned, shaped,
and filled short.  There are two very small PARL's noted at the periapex 
of the DB and MB roots on the CT slicing.   An MB2 was missed and the DB 
may have a very small file separated, at the apical curve (or at least it 
looks suspicious on the 3-D constructed image).  He also seems to have some 
mucocele's/sinus pathosis associated with the pneumatized sinus about the 
palatal root (lobulated cloudy radiopacity).

When I mentioned that I thought there might be some sinus path the patient 
revealed that he had chronic unilateral sinus symptoms (right side).

I didn't know if the findings would change the plan for the heart surgery 
and provided the physician with the findings.   The physician was very 
pleased to get the info and cancelled the surgery for next week, wanting 
to take no chances.  The new plan is to retreat the tooth in two steps, 
allow time for endodontic disease resolution and have the patient 
follow-up with an ENT specialist to assess the sinus status.  Once all 
these disease entities are eliminate he will have the surgery rescheduled.

The relative value of the CBCT was clearly obvious in this case.  If this 
had been a different patient presenting with routine health and did not 
require surgical clearance, the conversation would have been different. 
Without symptoms, without a need to replace the crown, and without PA 
radiographic signs of an obvious lesion, I would have presented the 
need for a CBCT as being much less but optional if the patient wanted 
to see if there was subtle chronic disease associated with the tooth.  
I doubt the patient would have elected to pay for a scan and I certainly 
wouldn't have tried to sell it - Terry

Protaper flaring

6 yr old Empress

Cvek pulpotomy

Middle mesial

Endo misdiagnosis

MTA retrofill

Resin core

BW importance

Bicuspid tooth

Necrotic #8 treatment

Finding MB2 / MB3

Deep in a canal

Broken file retrieval

Molar cases

Pushed over apex

MB2 and palatal canal

Long lower third

Veneer cases

CT Implant surgury

Weird Anatomy

Apical trifurcation

Canal and Ultrasonics

Cotton stuffed chamber

Pulp floor sandblasting

Silver point removal

Difficult acute curve

Marked swelling

5 canaled premolar

Sealer overextension

Complex anatomy

Secondary caries

Zygomatic arch

Confluent mesials

LL 1st molar (#19)

Shaping vs Cleaning

First bicuspid

In Vivo mesial view

Inaccesible canals

Premolar 45

Ortho and implant


Lateral incisor


Churning irrigant

Cold lateral

Tipped to lingual

Acute pulpitis images

Middle distal canal

Silver point

Crown preparation

Epiphany healing

Weird anatomy

Dual Xenon

Looking for MB2

Upper molar resorption

Acute apical abcess

Finding MB2

Gingival inflammation

Irreversible pulpitis

AG BU ortho band

TF Files

using TF files

Broken bur

Warm technique

Restorative prognosis

Tooth # 20 and #30

Apical third

3 canal premolar

Severe curvature

Interesting anatomy

Chamber floor

Zirconia crown

Dycal matrix

Cracked tooth

Tooth structure loss

Multiplanar curves