Etiology of the distal lesion - Courtesy ROOTS
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From: Roberto Cristescu
Sent: Wednesday, October 14, 2009 5:15 PM
Subject: [roots] Any doubts here ?
Any doubts about the etiology of the distal lesion here ?
High sinus tract, deep pockets (7 and 8 mm around D root).
The CBCT just confrimed what with the radiograph and clinical consult
it was almost obvious. Nice feature though on the CBCT software that
you can rotate the axis of the tooth and find out
also fractures situated in areas difficult to locate - Roberto
Do you believe that the CBCT-scan was the decisive factor in making
the diagnosis? I see a cervically located sinus tract, I see a laterally
located radiolucency, there is pocketing, all around an endodontically
treated tooth. To me, it has written root fracture all over it..
To my opinion, a CBCT-scan in this case superfluous, and unnecessarily
adding to the cost for the consultation.
I’d like to hear your comments. - Michiel
Hi Michiel, You are right, probably it was not necessary the CBCT in
this particular case. There were some clincal and radiological signs
that made me suspicious for a vertical root fracture (although there
was not an isolated deep pocket, but more pockets all around).
Since with a vertical root fracture the only option of treatment is a
very irreversible and expensive one: extraction and than implant or
bridge (in most cases, ofcourse doing nothing is an option also),
I am trying to have the best evidence/proof available . Knowing of
course that even with CBCT, even opening the tooth, even doing an
exploratory flap, we are not 100 % sure to rule out such a fracture
(we might have on all those tests false negative results).
If I didn't saw a fracture on this CBCT I would have gone either
for an endo start or for a flap to confirm my suspicion of VRF.
And than I would have condemned the tooth to extraction.
At least this is how I am thinking now. Thanks for your answer
and comments ! - Roberto
Keep this stuff coming Roberto. Thanks! - Mark