Do You See What I See? A Case Study

Xray scan of the teeth on the dark
Xray scan of the teeth on the dark

The image above is that of a Panorex: a two dimensional x-ray used routinely in dentistry for diagnosis.

If you’ve been to the dentist and stood in a machine that went around your head, then it was a panorex image that was being taken.

What does a Panorex show us?

A panorex is used to determine if:
1) Wisdom teeth are present and:
a) How many.
b) How developed they are (the maturity of the root system). It is ideal to remove them when there is a certain amount of root formation. We will discuss this further in a future blog called “Indications to Remove Wisdom Teeth.”
c) Their angulation and position within the jaw. This will be an indication of the level of difficulty in removing them.

The two wisdom teeth depicted in the image above are hi-lighted in red. They would be considered very difficult extractions, based on their angulation and position within the jaw…A good case for an oral surgeon or experienced general dentist who is used to removing difficult wisdom teeth.

It’s possible that the dental practitioner may advise the patient to not even remove them. This decision will depend on the relative risk they pose in their removal i.e. How old is the patient? How much will the extractions put the patient through? What is the risk of damaging the major nerve that runs below the tooth, such that the patient may be left with permanent numbness? Again, we will discuss these issues in a future blog.
2) Any pathology i.e. cysts or tumors that may be present.
3) Are there any teeth missing?
4) Are there any extra teeth present or are any teeth in a non-ideal location i.e. lodged in the palate.
5) If there are any large cavities present.

In the image above there is actually a tooth with a very large area of decay. So large, that the decay has most likely gone into the nerve. This means that the bacteria within the cavity have invaded the nerve…Now the only way to save the tooth would be to do a root canal procedure. Question: Are you able to find the tooth in question? It is located in the upper left area; the second to last tooth. It presents as a very large dark area on the side of the tooth.

The above are some of the key features that a panorex image will give us.

For the sake of completion we will mention some other areas that a panorex is useful in conveying. However, we will do this in the next blog.

Let’s take a break for now….Keep smiling!

Yours in good dental health,

Dr. F. Keshavarz Dentistry

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