Here’s a case that came into the office a few years ago.

The patient had been having symptoms and was medicated with antibiotics. They were referred to me for a retreatment. There was no information about when the original root canal was done but the obturation is thin and short and there is apical rarefying osteitis.

It looked at first like a straight forward crown access, post removal, and canal retreatment. On second glance at the film, I became a little worried about coronal leakage under the distal crown margin and the impact this might have on the prognosis of the retreatment.

So we took a vertical bitewing to check the crown margins:

Wow. Here we now have an ill-fitting crown, a much longer than expected post in MB that is heading to a perforation, furcation involvement, a probable perforation into the furcation, and on top of all of that…a crappy root canal.

I ended up recommending extraction of this tooth.

Moral of the story: Take different angled films and don’t forget about the usefulness of vertical bitewings.