From: Terry Pannkuk
To: ROOTS
Sent: Tuesday, November 24, 2009 3:56 AM
Subject: [roots] CBCT of Complex Molar Case Today

I scanned this patient (a 90 year old retired physician) just for Ivan this morning.
I started the endo as a two-step one month ago.  Everything about the case was worrisome,
fragile patient, limited jaw opening, spine problems, very narrow long mesial root
(24.75mm) with a dangerous looking mesial concavity.  Bulbous distal root end with
suspected complex anatomy, a large pulp stone, deep previous pulp cap restored into
the distal orifice, questionable existing restoration with stained internal dentin,
and a large chronic lesion.......normal perio though.

Today when I continued I found a very deep distal root trifurcation (didn't branch
until the 20mm level from the reference point.  I didn't really know it was a
trifurcation and thought it was a bifurcation when I packed it.  I fit two cones
having to insert the DB cone first to get the DL to slide into position on the
lingual branch.

The mesial root canal system was kept slightly conservative in width (for my tastes),
Two cones were fit to length and they were separate, which isn't obvious on the PA but
is on the CBCT scan which shows an irregular terminus with at least 3 major POE's shown
in the coronal section terminus slice on the lower left window of the scan jpg.

How do you think the result of this case would have looked if treated by a "biomimeticist"
thinking they needed to protect PCD instead of extend it in strategic areas,
then using carrier obfuscators?

I think not well. :):):) - Terry





Terry, Nice case. Excellent technique.
But one question.
I can see the added value of CBCT before RCT, or during follow-up.
Why did you take one, right after treatment? Just to show the anatomy?  - Rafaël

The CBCT was purely for me.  The patient was a retired physician and was fascinated
by all the gizmos at our office and I asked him if he wanted me to scan him for free;
he was thrilled to do it and fascinated by the images as I went through the slices with him.

You are correct there was no treatment value in taking the CBCT for this case other than
demonstration; I presented it that way to patient.  If the lesion doesn't heal and I end up
taking a another CBCT down the road I'll have a baseline.  At age 90, I'm not sure how
important that is going to be :) - Terry

Very nice work on this one, Terry.Our population ages and treatment becomes more complicated.
- Guy

Very nice case Terry, again showing the importance of finding that anatomy, not machining it,
good access and visualization, and the dynamics of obturation. Very well presented - Jose