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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 -
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.

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
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Cotton stuffed chamber

Pulp floor sandblasting

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Lateral incisor


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Crown preparation

Epiphany healing

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Dual Xenon

Looking for MB2

Upper molar resorption

Acute apical abcess

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AG BU ortho band

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Warm technique

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Apical third

3 canal premolar

Severe curvature

Interesting anatomy

Chamber floor

Zirconia crown

Dycal matrix

Cracked tooth

Tooth structure loss

Multiplanar curves