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ePaper created 2016-03-31, 16:35:38 | version 1.38.0
importance of diagnosis case report | 35roots1 2016 ·· the patient’s history, that is overall health, any dis- eases and/or conditions, systemic medication, etc. ·· the proper use of the appropriate diagnostic tools, including pulp testing, response to cold and hot, the bite test, radiographs and CBCT scans; additionally, the latest software can help usinreadingandanalysingthedatathatwehave, including in 3-D—I recall the words of my radiol- ogyprofessor,remindingustostudyradiographs and be attentive to every small detail, not just look at them ·· the logical connection between the patient’s ac- count and history, the clinical findings and the im- aging data—sometimes, putting the pieces of the puzzletogethercanbefast;sometimes,itmaytake longer. Oncethediagnosishasbeenestablished,thechoice of treatment modality and selection of the best tools toperformthetreatmentfollow.Atthisstage,focus- ingfirstandforemostonthepatient’shealth,itisim- portant to choose the most effective and efficient treatmentthatwouldbeasminimalasispracticaland sufficient. The rest should be taken care of by Mother Nature. Case presentation Case 1 The first case that I would like to present was a re- ferral patient. Sitting back in the chair, the patient started giving his account: over the previous six months, he had twice travelled to somewhere in Asia for surgery on his left-sided submandibular lymph nodes (Fig. 1), which had apparently been swollen. Each time, pathology tests were clear of any can- cer-specific markers. CT scanning and conventional radiographic assessment were conducted, with no findings recorded. Havingsharedthis,thepatientreportedthathefelt his lymph node becoming swollen again, and he was anxiousaboutit.Hisaccountwastakenveryseriously. Additionally, he reported that two of his mandibular premolars were aching, since root canal treatments had been started at a different clinic, but the dentist had been unable to finish them. With the patient’s permission, a new CBCT scan was obtained, and I asked the patient to wait for an hour to give me time to study it. Judging by the general view first and then going into local details, I realised the two mandibular pre- molars were indeed in need of endodontic retreat- ment.However,knowingfromclinicalexperiencethat premolarsmayhavevariousclinicalmanifestations,I continued looking for other sources of potential problems, but without disregarding the premolars as the culprits (Fig. 2). Fig.5 Fig.6 Fig.7