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CBCT Map Quest Directions to an MB2 - Courtesy ROOTS
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The opinions and photographs within this web page are not ours.
Authors have been credited for the individual posts where they are - www.rxroots.com |
From: Terry Pannkuk To: ROOTS Sent: Thursday, July 22, 2010 9:30 PM Subject: [roots] CBCT Map Quest Directions to an MB2 after a Barf Bag Rest Stop Yesterday’s Diary: I saw this patient last week (calcific dengeneration, Cox-Crapped Molar, gagging patient, refused to take Xanax, and couldn’t tolerate being reclined). I started treatment on this patient, she insisted on no drugs but needed them. She would have been a perfect candidate for IV sedation. I can’t remember the last maxillary first molar where I couldn’t find anything resembling a mesiolingual groove or an MB2 canal system but this was one. I ended up deciding to treat the 3 canals I could find and treat then take a CBCT post-treatment. She was having a tough time with positioning, felt hot, couldn’t recline, needed to constantly swallow, and was gagging during the entire treatment but refused meds and the suggestion of sedation. I’m a masochist so I decided to torture myself and try to treat her anyway. Right when I finished backpacking the palatal she puked all over my operatory and stained her white blouse with the blueberries, bananas , and oatmeal she had for breakfast right before seeing me. The tooth had a temporary crown which had been taken off so I had punched multiple holes clamped the second molar and ligated a forward anterior tooth with floss. When she Ralphed, it was a fire drill to stuff a big ball of Cavit into the access and simply rip the latex dam off without dicking around trying to remove the floss and deep distal clamp. Gary Carr would have been disappointed that I didn’t take the time to ergonomically capture a photo. After she went to the restroom, cleaned up, and changed her blouse into one of our assistant’s scrubs, I took a CBCT which was invaluable for today’s appointment. She thanked us all for being so patient but still refused the meds when I saw her today. She was better only in the sense she didn’t barf today, but it was still a struggle. The MB2 discovery was a very interesting CBCT process that I’ve done a couple times now. The coronal section of the MB root clearly demonstrated that there was a missed MB2.The MB1 was well to the buccal and the transverse sections showed a dumb-bell shaped outline suggesting a major untreated system. Only a faint hint of a patent MB2 was suspected but it was enough to identify it’s location and triangulate coordinates that I could transfer to the mouth and find it. It was still a leap of faith not seeing any pulpal floor map when penetrating with a bur.quite scary. The triangulation worked by drawing a line from the center of the palatal to the MB1 filled canals on a transverse section like this one: I then simply dotted the spot where the bury treasure was supposed to be and lightly brushed away the dentine until I cold start to uncover darker root dentin giving me a better clue where the white dot of the MB2 canal was to be. Fascinatingly it was right were it was supposed to be from the triangulation. I didn’t need to search and destroy and the canal finally revealed itself after deeper penetration than I ever would have dared if I hadn’t had the triangulated CBCT coordinates (1.5 mm mesial to the line connecting the MB1 and P canals and 3.5mm palatal from the MB1) The attached photos show the access sequence. I repacked the palatal because I had rushed the previous obturation while she was puking and had filled slightly short. - Terry
