hello everyone and welcome to the ninth episode of the Diary of an endodontist if you are not following us yet please subscribe to our Channel we are going to discuss lots of tips and tricks and if you like that if you want to enhance your knowledge and develop your clinical skills this is the series for you so stay [Music] tuned today we are going to talk about cases that you have difficulties when you take an x-ray it could be because of a landmark that is hiding the canal or it could be like a plate for
example in this case a plate when the patient had the orthogenetic surgery that titanium plate was screwed in in that area and this tooth as you can see was referred to us because there was probably deep carries in the past and the pp got contaminated and became necrotic and now the patient is in pain and you can see on the in the X on the X-ray that there is a paricular radiolucency this area is covered and the dentist didn't have the facility of a cbct and and was not feeling too comfortable to carry on with
the root canal treatment if you have the opportunity to take a cbct that is much better because then you can uh rotate your your um X-ray and you can see threedimensional and you'll be able to distinguish what is the plate and where the Apex is and how many canals there are but you have if you haven't got that option you have to remember that this plate is positioned buckly to the tooth and if you want to take an x-ray you shouldn't do the parallel technique if when you take the parallel technique if you have that
covering the Apex you need to angle the the X-ray cylinder so you can take that plate out of your view so completely out of the Apex line so compensate that with the X-ray and you'll be able to see the Apex in this case you thought probably that the canals were joined and when we we move that interference out of the apical portion we can see that the Apex is more complex than we thought although is it looks like uh you uni reticular tooth completely different than the six for example that has two or three roots
in this case three canals at least visible on the PA again if you take a cbct you you can see that in advance but I understand that it's not a reality to every practice it's getting there but it's still sometimes difficult so try to angle your x-ray even if you are using the holder and change techniques use The Parallax technique for example where you can compensate that image so the root canal treatment was done and you can see that the access was just oclusal if it's just oclusal and you have like a good bonding a
good strong composite uh core in that area and the patient is not a brist and there is no risk of fracturing that tooth you don't need to have that tooth crowned so I would say be as more conservative as possible it's not every tooth that had a root canal treatment done that will need h a crown so in this case as soon as we finished the root canal treatment the patient was having L it was getting a lot more comfortable the tooth in six month time the Toth was very comfortable back into function and you
can see that the area is healing so pay attention in this area because if you don't have the cbct you don't know if this is part of the lesion or if this is a a less corticated bone so it's the trabulus bone if you check the che years's review you can see that same color is over there and over there so I would say this is not part of the lesion and you can see the ladura around of this area in the two years uh review so I would say that is a a tooth that
the root canal treatment has been completely successful the Troth is back into to function and uh I think if you just have that in mind in terms of the X-ray to make your life easier not only during preop and during the treatment but also for your reviews I hope you are enjoying our cases and finding it very useful and that you have now started to use lots of tips and tricks into your daily routine so if you want to hear more about those cases or if you want me to discuss more cases different ones you
can you can put in the comments below and I I would like also to thank you all for particip ating to our group to our group discussion it's been wonderful to see lots of you here thank you very much and please stay tuned you take [Music] care
