Mandibular anterior shift

The opinions  within this web page are not ours.Authors have been credited  for the individual posts
where they are. - www.rxroots.com  photographs courtesy: Rob Kaufmann
From: Rob Kaufmann
Date: Thursday, November 1, 2007 3:25 pm
Subject: [roots] Mandibular anterior shift images
To: ROOTS

Mandibular right central incisor treated by General Practitioner who
practices approximately 4 hours away from my office (by car.)  The
referral film was sent to me because the periradicular pathology was
persisting as was the draining buccal sinus.   The patient had taken
multiple courses of Abs including Amoxicillin and Flagyl. Not only was
she tired of this whole process, she was beginning to have some real
GI upset problems after all of the Abs. This is NOT the type of case
where you can say" Why not stop in for an exam, so I can check you
over for 15 minutes and then reschedule you."  Its 4 hours drive EACH
WAY.

I examined the single referral film (awful) and the documentation that
was sent to me.  I concluded that if this woman was going drive in and
be treated in a single appointment, we would most likely have to do a
NSRCT and SRCT retreat if we were sure we wanted this thing dealt
with, once and for all.

I examined her today ( she was scheduled for the SRCT tomorrow a.m.)
and the sinus was draining purulent material. A periapical radiograph
( straight on) showed a decent endo procedure with a bit of sealer
overfill  nothing overtly wrong. I asked my staff for a shift shot
and was rewarded ( unfortunately) with something less than what I
wanted. While the sensor was being used in another room, I  explained
the reason for the retreat and the SRCT. I suspected a 2nd canal but
the patient was skeptical - she couldn't see it and neither could my
staff . (Remember, she only wanted to make ONE trip.) I suggested that
an NSRCT retreat two appointment( CaOH2 med)  procedure might be a
better option than SRCT but that she would have to come back for me to
do it that way.  We might be able to avoid the SRCT.

I then took the shift image myself. It showed a 2nd canal, filled only
with sealer, with excess extending out of the apex. This uncleaned and
improperly treated canal clearly was the reason for the failure. I
have her scheduled for tomorrow to perform the clean and shape and
CaOH2 placement. She has agreed to come back in 1 month and thereby
likely avoid the SRCT.

Watch out for those 2 canal anteriors - staff taking films can easily
miss them without a proper (and seemingly excessive !) shift film.

Rob Kaufmann DMD MS(Endo)




Nice  - Glenn

That is teaching at its best ..............Thanks Rob - Sachin

Yup...patients will agree to multiple visits when we properly explain the
benefits of optimal treatment. - Fred


Of course, this patient did not need to risk life and limb for another eight hours
of dangerous highway travel, or undergo another invasive procedure, and all
for very questionable benefit.

This patient needed a MISSED CANAL TREATED ... Wasn't that the teaching point?

Those missed canals can be very annoying!

Ignoring these canals is certainly less than optimal; it's not treatment at all.
This patient will heal because the canals have finally been treated, even if
inefficiently. - Ron

That's the kind of stuff we need to get back on roots.  bravo rob.  You
totally rocked on this one, and provide an excellent learning experience for
all of us.  Superb! - Gary