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Endo tips    Better Endo    Endo abstracts    Endo discussions

Etiology of the distal lesion - Courtesy ROOTS

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: Roberto Cristescu
To: ROOTS
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.

Id 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
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

Radioluscency

Lateral incisor

Obturation

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