Do you see anything that catches your eye on the periapical radiograph (above left) taken recently in my office? Perhaps the title here gave it away but what caught my eye was the irregular pulpal space. My thought immediately went to questioning if this was just his normal (yet unique) pulpal anatomy, or perhaps something else.

I could have taken off-angle radiographs to further evaluate. However, I have a Cone Beam CT available in my office and my patient and I came to the consensus that a CT scan would give us the clearest picture of what was happening.

As you can see in the screen shot from the CT (above right), it was unfortunately a resorptive defect compromising the tooth to the point that it will be lost. It would have been ideal to catch this defect earlier; however, it wasn’t possible since this patient had not been in years.

John R. Carson, DDS, PC, Spear Visiting Faculty. [ www.johnrcarsondds.com ]

Learn more about resorption in addition to techniques relating to implants, occlusion and treatment planning from Spear Digital Campus. View the free lesson:
Connecting Implants and Teeth.


 

Comments

Commenter's Profile Image Rich Rosenblatt
May 8th, 2013
I had the same thing happen the first week I had my cone beam. What a great addition to the practice!
Commenter's Profile Image Cheryl Freeman
May 9th, 2013
When you mention that it would have been ideal to have caught this earlier, do you feel that endodontic treatment would have prevented the progression of this process?
Commenter's Profile Image John Carson
May 9th, 2013
Yes Cheryl if it had been caught earlier endodontic treatment may have been able to be done in an effort to save the tooth.
Commenter's Profile Image Tung
May 9th, 2013
The lingual lesion makes it next to impossible to manage surgically. If caught early, we could have tried placing calcium hydroxide in the canal in hopes to arrest the progression. Not matter what, the prognosis was guarded to unfavorable.