From: Terry Pannkuk
To: ROOTS
Sent: Friday, December 18, 2009 9:50 PM
Subject: [roots] Working on the Railroad-CBCT

Here's an interesting patient that presented on recall.  The patient and her dentist are amalgam-phobes.
I really wanted to pack in an amalgam core after I treated the endo on #2 9 years ago.  The crown was intact after
the endo treatment but it had been severely weakened by pins and other WMDD's (weapons of mass dentin destruction).
I wasn't allowed to follow up the endo with a build-up so I didn't. Predictably the crown fell off a year ago and
the patients dentist in an attempt to save the patient money made a hole through the occlusal surface, pounded a
couple of gold railroad spikes into the MB2 and P canals and recemented it back on, all with a rubber dam
I'm sure. :):):):):):):)

The patient presented a couple weeks ago with vague biting sensitivity in the area. It was not localized.
Both #2 and #3 tested equally sensitive (slightly) to percussion and biting.  The PA was inconclusive although
I suspected a lesion on the MB root of #3.  I prescribed a CBCT and these are the images I got.

#3 had been treated by some unknown clinician at some unknown time prior to 2000,  Below is an additional coronal
section showing the MB1-MB2 area of the MB root of #2. - Terry