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CbCT case #2 - locating canals - Courtesy ROOTS

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credited for the individual posts where they are - www.rxroots.com
From: Rob Kaufmann
Sent: Monday, June 28, 2010 7:06 AM
Subject: [roots] CbCT case #2 - locating canals

Here's a case that I started on Friday.  Patient arrived with draining buccal sinus and percussion sensitivity
in the right first mandibular molar. Tooth had been restored multiple times and  crowned many years ago.
No responses to pulp tst or cavity test.  Access was a bitch. There were literally NO landmarks left as the
chamber was totally and completely calcified. At that point I was finding the canals "buy color". Lookig for
the border between the white vertical dentin surfaces and the darker apical dentin, I located the ML and D canals
- took me an hour.  Because of the crown, I had no landmarks and I was not sure a to which of the M canals
I had found ( they looked quite close together on access and the  calcification did not help matters.
I started looking lingually but there was a lot of "white" and that generally is not a good sign.
I decided to stop, placed Ca(OH)2 in the canals I did find and took a cbCT at that point.

The cbCT clearly showed that I missed the ML - AND that it joins the MB short of the terminus. Ca(OH)2 meds
slightly out of the foramen.  The next time she returns, finding the canal will be easy.  Without that,
I probably woudl have ended up hogging out the access even more that I have already. - Rob Kaufmann DMD MS(Endo)

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