nyuszisie,

Dental Radiographs are a two dimensional picture and depending on the angle that they were taken and the quality of the x-ray, x-rays can tell one aspect of the story while clinical examination gives an additional diagnostic view. Panoramic films are not intended to take the place of single periapical and bite wing films. It is important that all aspects of the mouth be evaluated and not just one or two.

The panoramic x-ray that you posted is lighter than ideal (that is due to the amount of exposure that was used to take it, not because it was copied) so it is not possible to see every tooth clearly on this film. With that said, I will share my radiographic findings based on the this film that you posted on this site. I am unable to move that film to this page...otherwise I would.

Over the years you have had several teeth removed which has caused your existing teeth to shift out of their anatomical position. So it makes it difficult for me to be accurate with posterior teeth numbers. It looks like the shifting and missing teeth have both contributed to a misaligned bite which is has caused some excessive wear on your teeth especially your upper front 6 teeth.

The upper right quadrant...........
You are already aware of the remaining remnants of the root canal material. The extraction site appears to have been somewhat cleaned out but not completely. This could be why you still have that puffy feeling in that area. This site may or may not heal completely. It is a judgement call as to whether a surgeon would be comfortable going in and debriding it at this point.

Also in the upper right quadrant it appears that you have some pocketing in between teeth #4 and 5 and 5 and 6. This could be due in part to the bacteria that resides on the inside and outside of tooth #5 the first pre molar. This tooth also appears to have some pathology at the apex of both roots. That could be the same dark circle that was seen on the ct scan and possibly a cyst forming. Again, the formation of a cyst is typically seen with root canaled teeth. But don't mistake typical to mean okay.... this is not a healthy tooth. It may even have decay but that is not clearly evident on this film.

The upper left quadrant....
Tooth #11 the lateral appears to have excessive wear on the lingual (back) portion of the tooth but it is vague on this film. Tooth #12 the first premolar appears to have some pathology going on surrounding the root structure of this tooth. Then you have a space where a tooth is missing. It appears that there is cystic and bacterial pathology in the bone partially in this space attached to the molar directly behind it. This molar I'll refer to as #14 and it has been root canaled. It has a very large area of radiographic pathology, possible decay and possible fracture of the root system. This tooth does not look healthy and definitely needs further evaluation. There appears to be a deep pocket between #14 and #15 the last molar in that quadrant. This last molar may have decay and pathology also.

The lower left quadrant...
The first molar #19 has a deep restoration and appears to have decay or a defect underneath the filling. There may also be radiographic pathology at the end of the distal (back) root of this tooth.

The lower right quadrant...
There could be recurrent decay underneath the filling on the first molar which I will call tooth #31.

Panoramic x-rays are diagnostic when looking at the upper and lower jaws in their entirety and when viewing the position of wisdom teeth along with some other anatomical structures like the partial sinus and jaw joint. However this x-ray is not intended to take the place of single periapical films and bite-wing films. Both of which are absolutely necessary to confirm various dental problems such a the ones that I have commented on here.

If your dentist has not mentioned any of these findings to you, then please seek a different general dentist for a full examination with all of the necessary x-rays.





[QUOTE=nyuszisue;1070701]Yes, I would like you to tell me what do you see on the panorex. Please.
Thank you !