CBCT slice of mesial root shows the two mesial canals join and exit at one apex.
This is another slice of mesial roots showing the buccal filling and the ML missed canal. The sagittal view tells us where to look when we retreat this tooth. Axial view also demonstrates the missed canal. Using these two views, when I retreat this tooth, I will know where to explore without perforating the root.
This particular endodontist refunded the patient and preferred that we retreat the tooth at our office.
This root canal was treated by another endodontist and then retreated after symptoms failed to resolve. She came to Superstition Springs Endodontics for a second opinion. The obturated roots look filled to an ideal length.
CBCT reveals a missed MB#2 canal. Blue outline shows an axial slice of the MB root. The pear-shaped root outline reveals the missed canal.
The sagittal view also shows the MB#1 canal is off center of the long axis of the root. A lesion into the sinus cavity is noted. Note the distinct MB lesion visible in the CBCT. I explained to the patient that it would be the other endodontist would likely retreat this tooth at no charge, but this patient has elected to retreat the tooth in our office.
CBCT shows lesion on MB and DB with elevation of floor of sinus. This corresponds to chronic sinus issue patient has been dealing with.
Cross sectional slice (axial) through the MB root shows the missed MB#2 canal. The pear-shaped or figure-8 shape of the MB root reveals the missed MB#2 canal.
This sagittal view shows that the missed MB#2 canal is actually a separate root. While the roots are fused all the way down, it has its own apex.
The CBCT is a map for retreatment. It tells us exactly where to look to find the missing canal.
This patient returned to her previous endodontist for retreatment.
I know each one of these endodontists, and they all do excellent work. I confidently suggested to each of these patients that they return to their previous endodontist for evaluation. Using the CBCT map for retreatment, I am confident each one of these endodontists will find the additional canal. One endodontist is retreating at no charge, one endodontist is refunding patient and she will have treatment in our office, and the third patient did not want to return and has elected to pay for retreatment in our office.
CASE #4 - My Missed Canal Found with CBCT
I completed this RCT in Nov 2011. Palatal lesion seemed to improve, but patient symptoms returned. In this particular case, I found only 2 canals. After extensive searching under the microscope, I determined that this must be one of those tricky 2 rooted Mx molars. Since symptoms returned, we took CBCT to see if I missed anything.
CBCT reveals that I did miss a DB canal. However, looking closely at the axial view, my assumption that this is a 2 rooted molar was correct. The palatal and DB roots were fused as one. Sagittal view shows the missed DB canal. Axial view shows the missed DB as well. The CBCT is now a map for retreatment.
As explained, the axial and sagittal view provided by CBCT is invaluable. More information provides for better treatment. This post should demonstrate the level of complexity of molar endodontic therapy even with the use of the operating microscope and the benefit of 3D imaging over 2D imaging alone.