A "borderline" dental trauma with 12 y of evolution justifying CBCT as diagnostic method

Abstract

The case of a female with a history of trauma to her maxillary central incisors 12 y ago is presented. The right tooth showed signs of root-fracture healing with a dislocated coronal fragment, total pulp canal obliteration (PCO) and contradictory signs and symptoms. The left tooth showed an indistinguishable fracture line but partial PCO in the apical fragment and normal clinical signs. Although the patient was referred for endodontic treatment of the right central incisor, Cone-beam computed tomography (CBCT) was suggested to confirm the nature of the condition. Because CBCT should not be used routinely for endodontic diagnosis but may be justified in "borderline" cases, it was performed in according to the current legal recommendations, avoiding the unnecessary endodontic treatment. PCO is discussed, as the condition involves not only a radiographic reduction of the pulp canal but also an adaptive morphological pattern of pulp response to trauma.

Morfología inusual de raíz y canales del primer molar mandibular, como indicación de tomografía computarizada de haz cónico: A propósito de un caso endodóntico "fronterizo"

“…CBCT reproduce imágenes tridimensionales permitiendo la exploración en planos sagitales y coronales, proporcionando así, información precisa sobre la morfología radicular y canalicular, siendo su uso recomendado en casos de variaciones en la morfología radicular y canalicular (2) . Ya ha sido sugerido el empleo de CBCT para casos de morfologías radiculares aberrantes (12) ; sin embargo, y según nuestro conocimiento, la atención cautelosa a las indicaciones precisas de CBCT apenas ha sido reportada en este tipo de casos (21) . Más allá del atractivo que supone esta tecnología, su aplicabilidad diagnóstica, terapéutica e incluso investigativa es hoy motivo de profunda discusión para casos como el que se presenta.…”

New evolution of cone-beam computed tomography in dentistry: Combining digital technologies

“…It provides the surgeon with 3D-reconstructed images for analysis of the nature of the injury, the location of the fracture, and the degree of displacement of the fractured segments. These images guide the surgeon to plan the appropriate surgical approach for the reduction and stabilization of the fractured segments 45. Mandibular fractures are easily visualized on a panoramic radiograph in most cases; however, some cases require further confirmation by CBCT, including dislocation of fracture fragments in the mandibular corpus and split fractures in which the fracture line is not parallel to the X-ray beam 46.…”

“…To facilitate better treatment of trauma patients, CBCT should be made mandatory in maxillofacial and suspected mandibular fractures. This technique should be used in conjunction with panoramic radiographs, which are useful for the initial screening of complicated fractures 4546…”