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ePaper created 2016-03-31, 16:35:38 | version 1.38.0
| case report importance of diagnosis 36 roots1 2016 Analysing the CBCT sections, trying different fil- ters and settings, looking at the mandibular molar with a large filling, and studying the bone around it, myeyecaughtsomethingunusual.Therewasasmall abscess migrating towards the internal angle of the mandible (Fig. 2) and creating an area of bone ero- sion(Fig.3).Thiscouldbethepathologycausingthe patient’s suffering, in addition to the two mandibu- lar premolars. At this point, one might be happy with the diag- nosticfindingsandracetotreattheproblemsaffect- ing the mandibular dentition. However, still unsatis- fied with the overall findings, I turned to analysing themaxilla,whereIfoundthatthesecondmolarhad internal decay and cervical internal resorption, cre- ating an infection pathway into the maxillary sinus (Fig. 4). I explained the situation to the patient and pro- posed retreating the two mandibular premolars, as well as conducting primary root canal treatment on the mandibular molar and the maxillary molar. The patient agreed, and the four treatments were per- formedinonesession,usingtheTFAdaptivesystem (Kerr) for shaping and EndoVac (Kerr) for chemical preparation according to the “A” sequence of irriga- tionprotocol,2 followedby3-Dobturationoftheroot canal system using the Elements Obturation Unit (Kerr; Fig. 5). Antibiotics were prescribed for the pa- tient to help his body combat the submandibular in- fection. Although I prescribe systemic antibacterial medicationveryrarely,Ididsointhiscasebecauseit was not clear what had happened with the lymph nodes and if they were still functional based on the immediate postoperative radiographs of the man- dibularmolar(Fig.6)andthemaxillarymolar(Fig.7). A minor postoperative reaction (moderate pain, no swelling)wasobservedandhadcompletelyresolved a week later. Case 2 The next clinical case is somewhat similar and involved an extra-oral sinus tract (Fig. 8). A mid- dle-aged female patient was referred to the office withanextra-oralfistulaintheposteriorsubman- dibulararea.Accordingtothepatient,shehadhad no pain or swelling and the fistula had appeared several weeks before she presented to the clinic. At first, she thought it was a skin problem, but then realised that there was pus draining and the opening was growing larger. Upon consulting with a dermatologist, who said the problem was most probably of dental origin, the patient con- sulted her dentist, who had previously placed an implant for her. The dentist thought the infection was associated with her third molar and not the implant, and suggested extraction of the tooth. The patient wanted to retain the tooth and hence sought an endodontic consultation regarding this option. Fig.8 Fig.10 Fig.9