From: Fred Barnett
To: ROOTS
Sent: Monday, December 21, 2009 9:02 PM
Subject: [roots] MSDO- before and after endo tx

Treatment by Mike Trudeau; tooth #14. Jared Buck; tooth #13. - Fred



Superb!Thanks for sharing! - Liviu

Excellent outcome! Looks like Mike drew the short straw though ;-) - Stephen Ball

Fred, Good endo treatment, but from what is seen on CTs the lesion pointed with an arrow hardly could be of
odontogenic origin in my humble opinion.

Besides two CTs have been made at quite different planes. The cut of CT from 2009 is at higher level/plane
than CT from 2007. Should be at the same level/plane to allow real comparisson. Looks like this
retention cyst have subsided within this 2 years period ( or been removed ... ? ).

Just my 2 cents - Valeri Stefanov

Here is another picture of pre-op and follow-up.....slices appear to be better matched. - Fred



Fred, From left CTs it is not clear when "diagnosing" CT was made ? Was it in July 2009 ? Hardly possible,
if check up was done in Feb 2009. How long time passed between first and second CT ?

Due to artefacts on starting CT it is hard to say, if there was an involvement of sinus bone floor. On check up CT
it is evident that the bone floor is very thin. If there was any involvement of teeth treated, then it has been via
different path. Bacterias from teeth possibly have reached the pre-existing lesion through "blood way" and
have caused a chronic inflammation of the lesion.

There is still thickening of the mucosa seen on the check up CT. Bone floor is fully intact, too.- Valeri Stefanov

Valerie, Good point.  I have other slices that I can include. Her sinus symptoms resolved a few weeks after the endo
was completed, so we made the assumption that this was MSDO.- Fred

Fred there are more discrepancies, too. The CT with the lesion is marked as done in July 2009 and a check up CT was
done in February 2009 ???? There is no evidence of  involvement of the sinus bone floor, and at least on this slice,
lesion looks like originating from sinus mucosa. Would be interesting to see other slices, too - Valeri Stefanov