Tooth #29

Cone beam computerized tomography (CBCT) used to enhance diagnosis and treatment planning.

Cone beam computerized tomography (CBCT) used to enhance diagnosis and treatment planning.

Pre-Op
CBCT Sagittal View
CBCT Coronal View

Diagnostic and Treatment Considerations

  • Radiographic difficulties: Moderate difficulty interpreting radiographs
  • Canal & root morphology: Mandibular premolar with two roots
  • Radiographic appearance of canals: Indistinct canal path

 

Preoperative evaluation and clinical testing supported a diagnosis of pulpal necrosis with symptomatic apical periodontitis. Conventional radiography displayed a mandibular premolar with atypical root morphology. Further study using Cone Beam Computerized Tomography (CBCT) disclosed the presence of a horizontal root fracture.

 

All other considerations aside, the presence of a mandibular premolar with two roots would have made endodontic treatment very difficult. However, the additional diagnostic information obtained by the CBCT helped to determine
a more appropriate treatment plan (extraction) avoiding endodontic failure and further complications.

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