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To CT or not to CT- C-Shape

From: Terry Pannkuk To: ROOTS Sent: Saturday, May 15, 2010 9:38 AM Subject: [roots] To CT or not to CT- C-Shape Hereís a good puzzle case thatís bound to get different answers: Is it the standard of care to CT scan this tooth with complex anatomy, if you have a CT machine? Does a CT help with treatment execution? List the advantages of taking a CT. Attached are photos of todayís initial access. I placed calcium hydroxide and plan on finishing it in a month. Should I turn the referring dentist into the police if he wonít allow me to remove the bridge and recommend that it be replaced with implants? JJJ Any additional questions? There was mesial canal orifice, a distal canal orifice and a middle canal that I could sneak a file in the center of the C which required a little finessing to clean and shape. At the end you can see three orifices mesial, distal, and middle C - Terry I think wisdom, clinical experience, clinical ability, "knowing one's own limitaitons", and ethics/morality all combine to play a role in these decisions.......i would "sub title" this s pecifically to endo by the fact that a freakin KEEN sense and study of dental anatomy can set you free........ nothing can replace the accumulated data that comes by studying and experiencing each one of your own cases as a potential learnign experience that which can supply you with the inductive reasoned solutions of your tomorrow. "always" and "never" are unacceptable perspectives. you gotta think, meander, hit/miss, duck, dodge and keep an open eye and ear at all times....................it's a thinking man's game. for this case the xray doesnt really warrant a cbct based on the anatomy that is revealed in that 2-d picture. i would have moved forward as you did. but as you progress in life, practice and on a per case basis, you should be learning as well. once this case was opened it showed complex internal anatomy that was not necessarily spelled out on the pre-op 2-d exam. soooooo if: the anatomy moves beyond your clincial ability, expericne or comfort level, what is the crime in stopping and supplying yourself more data that will help you solve this anatomic riddle?.............. ie: freakn stop and take a damn cbct so you dont "f" the case up and/or you maximize your effort FOR this patient......which IS a clinician's calling... but if things progress smoothly and you achieve your desired result from your established goals and the result matches your clinical knowlegde, experience and perspectives, then what is the crime in moving forward without the cbct? i say there is no crime based on a clinician to clinician individualized ablity and perspectives in comparison to a "bigger picture". what i mean by that is we are all called to duty to properly anaylze and compare and contrast our own work to the "absolute" and make the proper ethical and moral adjustments. ie: i am an avg clinician but have a great perspective on what should and can be accomplished. i met my individual goals but when i viewed the final result and compared to the "absolute" result that could be achieved, the question should be asked: "should i go back and do more?" "would a cbct add to my final result and get me closer to the 'absolute'?". In contrast if the clinician is of great clinical ablity, wisdeom and perspective and achieves the absolute result in comparison to his/her own work, then there is no necessity to go and add more "insult to injury" or "run rule" a "team" you have thoroughly "usurped" by exposing a patient to unnecessary radiation. we all hvae a call to duty to judge ourselves for what we are, know the "absolute" and properly practice and make adjustments in our own offices based on that knowledge............granted this is a dream society that i speak of...........as no one does this...:-).... but ME!!!.. :-) enclosed is a case as an example of point. the case was obviously calcified. the pre-op xray showed no canal and there were likely limitations associated with collecting data from this "vector". clinical experience, proper equipment, ability and previous expsoure to this type of case allowed me to approach the situation in an "as is" perspective and move forward. well it was a tough case with tough anatomy and the first "final" xray certainly didnt reveal itself as the resutl that i expected to see. it certainly was less than "absolute" when a logical and honest comparison was made....... so i stopped, sent the patient for a cbct.......ie: this is a good place for more "data".....From this i gained perspective, data and therefore confidence to move forward and achieve the true final result that is shown.... summed up: it's a thinking man's game........you gotta take in all in and call it like you see it based on your time, place and issues that come. one day you might do "x" and one day you might do "y" but you have to constantly be comparing to "self", "neighbor", "town", "country", "planet", "universe", "galaxay" and then back again..... "i drive my car, not aim it" fits here...... :-) my .02 - Craig Barrington
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