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32 DENTAL TRIBUNE Middle East & Africa Edition | January-February 2015CAD/CAM < Page 31 Mark Limosani D.M.D., M.S., FRCD Dr. Limosani received his D.M.D. degree from the University of Montreal in 2007. He attended the specialty program in Endodontics at Nova Southeastern University where he also received his mas- ter’s degree in dental science. Dr. Limosani is a Fellow of the Royal College of Dentists of Can- ada and a diplomate of the Ameri- can Board of Endodontics. He is currently on staff at Miami Chil- dren’s Hospital and teaches at the AEGD residency program at Com- munity Smiles. Dr. Limosani has lectured locally and internationally on dental trau- matology, restoration of endodon- tically treated teeth, restoratively minded endodontics, diagnosis and treatment planning and cone beam computed tomography (CBCT) use in endodontics. Would you like to know more? Visit us on the web at www.care- streamdental.com About the Author Figure 2: Oblique sagittal CBCT view of #3 with attenuation patterns suggestive of a narrow bony defect associated with the MB aspect of the P root of tooth #3 (red arrows) Figures 4 & 5: Operating microscope intraoral photographs of the partially debrided tooth # 3 with the finding of a crack extending from the mesiobuccal canal through the palatal root Figure 3: Axial view with finding of an unaddressed MB2 canal (yellow arrow) and furcal defect (blue arrow) on #3 ter muscles did reveal some trigger point sensitivity sug- gestive of myositis possibly subsequent to parafunctional habits. Tooth #3 demonstrated slight sensitivity to biting, pal- pation and percussion. A 6mm probing was noted on the me- siobuccal (MB) aspect of the palatal (P) root. This finding was concomitant with puru- lent discharge. The PA radiograph (Figure 1) demonstrated that tooth #3 had previous root canal treatment. Probable radiolu- cent findings were associated with the apical portion of the MB and P roots. The root ca- nal filling material associated with all three roots appeared underextended and under- filled. A decision was made to take a cone beam computed tomography (CBCT) scan in order to obtain more valuable diagnostic information. Findings The sagittal slice demon- strated attenuation patterns suggestive of a narrow bony defect associated with the MB aspect of the P root of tooth #3. The axial slice demonstrated the high likelihood of an un- addressed second MB canal as well as a furcal defect involv- ing the MB and palatal roots. No radiolucent findings were associated with the apical por- tion of the MB root. Treatment Plan My endodontic diagnosis for tooth #3 was a previously en- dodontically treated tooth with an acute apical abscess. The differential diagnosis associ- ated with the etiology of bone loss was assessed as follows: 1) A crack extending from the MB root to the P root 2) A sec- ond mesiobuccal (MB2) canal that was unaddressed during the initial therapy that was causing persistent periradicu- lar periodontitis. The patient was given the op- tion to have the tooth extract- ed or to re-access the pulp chamber in order to investi- gate the presence of a crack or missed canal. She agreed to access the tooth, where upon a crack was discovered (Fig- ures 4 and 5), extending from the MB canal through the pal- atal root. Testimonial As clinicians, we can all recog- nize the importance of man- aging patient expectations prior to initiating treatment. When explaining all poten- tial risks and benefits associ- ated with our intervention, it becomes imperative for us to gather a significant amount of evidence in order to allow the patient to make an enlight- ened decision. CBCT helps uncover another layer of the dental diagnostic truth, while concomitantly enabling us to properly document our deci- sion making process. The CS 8100 3D extraoral im- aging system is an integral part of treatment planning and has provided me the resourc- es to make my discussions with patients more thorough and meaningful. It enhances the value of the care I provide. CBCT technology provides practitioners with another level of comprehension both from a diagnostic and a case management perspective. With 3D imaging, we are able to evaluate cases more ac- curately, while at the same time providing the patient with more effective diagnostic tools that minimize additional costs, procedures and discom- fort. BRAND PR MISE Q U A L I T Y S E L E C T I O N P E R F O R M A N C E Rely On Us for Quality, Selection and Performance. Henry Schein is a name you can trust. Our Brand Promise We provide the broadest selection of relevant products in the industry at the best possible value, to help you run your business more profitably. We stand behind all of our products with a 100% guarantee of satisfaction. Our products offer you maximum value without compromising on quality. We offer over 8,000 products you can trust to fulfill your needs—each bearing the Henry Schein Seal of Excellence— your guarantee of satisfaction. • Growing selection of value-priced products • All essential categories including diagnostics and infection control • High standards of quality and effectiveness Contact: Antonio Plata Phone: 631-843-5325 email: antonio.plata@henryschein.com 14ER3194 Dental Tribune_A4_Layout 1 12/2/14 4:15 PM Page 1 14ER3194 Dental Tribune_A4_Layout 112/2/144:15 PM Page 1