Even before the 3d cone beam scan, this problem wasn’t much of a mystery… but treatment options were.
If you guessed the patient has a periapical lesion on ECT #2, you’re a winner! The bonus question is whether to retreat and keep the tooth, or extract it. The patient really wanted to keep her tooth and the doctor really wanted to see what he was dealing with, so they both showed up at Reveal Diagnostics. After a quick 15-second 3D dental imaging scan we had the below sagital (buccal) view.
This view only shows one dimension of the area of interest. True, the CBCT image bisected the buccal roots and allowed a better view of the abscess, and the cone beam image revealed previously hidden pathology in the maxillary sinus. We have more data than when we started with a 2D pano. However, one plane does not tell the whole story or answer the main question. Namely, can this ECT tooth be re-treated with a reasonable expectation of success? Before you pounce on the slippery definition of “success,” look at the 3D image from all three angles below.
The coronal (cross-section) and axial (top-down) views show the patient has no cortical bone on the buccal side of #2, not even at the root apex. In addition, only about 1mm of bone remains lingually and to the maxillary sinus cavity. Upon seeing these 3D cone beam images, the referring doctor decided to extract the infected tooth. I won’t judge if it was the right or wrong decision, but I will say the doctor’s judgement was based on as much 3D diagnostic information as possible.