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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

Here’s a good puzzle case  that’s 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 today’s 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 won’t 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