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Endoscopy for Diagnosis
Below are some of the diagnostic uses for The Perioscope.
Root Fractures- I have received a large number of referrals from endodontists and general dentists seeking to determine whether or not a particular tooth was fractured prior treating it endodontically. Obviously, if a vertical root fracture was present, the prognosis for the tooth would be in question. Initially, I hoped that the endoscopic diagnostic procedure for suspected fractures would simply involve inserting the probe into the periodontal pocket, then finding and recording in the image of the fracture. Unfortunately, this simplistic approach was rarely successful.
Fractures by nature generate large inflammatory lesions often marked by significant granulation tissue. The pocket wall adjacent to a fractures usually bleed heavily upon manipulation. Often, the fracture is adjacent to a very deep and narrow vertical bony defect that can extend nearly to the apex of the affected root. To manage these factors during endoscopic imaging several modifications were required to the usual subgingival imaging method. The first modification I usually made was to increase the irrigation flow to flush away the pocket hemorrhage. Also, I found that in greater than 80% of the fractures referred to my office, the gingival cuff required surgical relaxation by making a limited sulcular incision. In doing so, the endoscopic probe could be easily inserted to the depth of the lesion and modification of the viewing angle could be obtained without concern of perforating the gingiva. To further aid the imaging of the fracture I removed as much granulation tissue as possible by gently performing a curettage. Finally, I have learned to become very patient when exploring for fractures. Just because the fracture is not immediately imaged, does not mean that it is not there. Moving the endoscopic probe just slightly to vary the angle of illumination often "lit" up a fracture in such a way that it became highly visible.
Here is a clinical series of a vertically fractured first molar. The mesiofacial probed 11mm and demonstrated exudation.
Below are the endoscopic images demonstrating the fractures. The shield is oriented at the top of the screen and the fracture is seen as a whitish line
Subgingival caries- Subgingival caries is readily viewable with the endoscope. Since this type of caries is usually found within the first 3 mm of pocket depth, it is easy to find. Usually, there is little or no bleeding to contend with. While imaging a normal root, a smooth, light surface suddenly gives way to a deep cavernous void. It is usually filled with an easily removable dark, amorphous substance that I would assume is a combination of subgingival plaque, decaying food and various organic by products from the caries process. The magnification and intense lighting help to elucidate the complexity of the biologic processes than occur within the subgingival caries micro environment.
Root resorption- These sites differ dramatically from subgingival caries. They are characterized by root concavities, that are steep indentations which are tissue filled. Often, bleeding is heavy near a resorption, so irrigation flows need to be increased.
Dental Endoscopy C.E. Review for Dental Professionals
As always, Aymee and I welcome your referrals and would be happy to discuss any case where you think endoscopy may be beneficial for your patient. Your confidence is appreciated!
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