01 September 2021

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Case study #3: CBCT and the advantages of using 3D radiology

Authors: Prof Dr Daniele Cardaropoli, Dr Alessandro Roffredo

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Female patient, 65 years old, requested a visit for widespread pain in the second quadrant, particularly localized in the molar area.
The intraoral periapical examination (Fig. 1) reveals bone resorption at the distal root of element 2.7. The periodontal examination shows probing on the distal side and the vestibular side, with exudate.

We proceed with the causal therapy through subgingival instrumentation of the pockets.

Upon re-evaluation after one month, the patient reports that she has not benefited from the therapy, persisting the symptoms that have even spread to the subzygomatic area. Furthermore, even at the periodontal examination, the probing has not decreased despite sufficient plaque control. . It was then decided to proceed with a second level X-ray examination justified by the diagnostic insufficiency of a two-dimensional X-ray. Accordingly, we opt for an 8x6 FOV with a "Regular" program to bilaterally investigate the maxillary sinuses and the entire maxillary arch to search for periradicular bone resorption.

The CBCT performed showed a patent and well-ventilated right maxillary sinus. In contrast, the left maxillary sinus was full of beacon material compatible with the presence of an infectious-inflammatory pathology. In addition, the sagittal cuts made it possible to highlight the presence of a bucco-sinus communication at the level of element 2.7, the cause of the patient's symptoms. In particular, the communication has created a path that runs along the buccal surface of the tooth in question. At this point, the case will be managed in an interdisciplinary way together with the otolaryngologist colleague.