Beam Computed Tomography (CBCT) is a valuable tool in endodontic
diagnosis. The following case illustrates how CBCT provides added
diagnostic information not available through traditional 2D imaging.
9 days ago pt reports pain to chewing & closing teeth together.
8 days ago swelling began. Pt went to ER and was given zithromax, ibuprofen & tylenol #3.
7 days ago swelling increased under tongue and into face.
days ago, pt returned to ER where they did a CT scan and found nothing.
Pt reports numbness in lip. Pt admitted to hospital and given IV
clindamycin. MRI done and “something was found in lower left jaw”. Pt
started 300mg clindamycin.
Today, patient referred from oral surgery for endodontic consult/vitality testing. Here’s how he looked.
small crack noted on the distal marginal ridge of #18. Thermal testing
once again indicates a vital pulp. Typically,we would expect a
necrotic tooth to be the source of the submandibular swelling that this
patient has experienced.
is responding normally to thermal testing,we decided to take a CBCT to
look for more evidence of the source of infection.
coronal slice (.25mm) shows radiolucency around the distal root #18.
This image is more conclusive than the standard 2D image.
CBCT slices are conclusive enough to revise the pulpal diagnosis to
“partially necrotic” and recommend endodontic treatment. It appears
that the distal root is necrotic and the infection is spreading through
the lingual plate.
2. Reversibly Inflammed
3. Irreversibly Inflammed
things are not always a cut an dry as that. This case illustrates that
“partially necrotic” pulp is a possible classification of pulpal status.