[Doitashi62]

Hi Bryanna,

Can you please take a look at these PA x-rays and let me know what you see? The recent PA x-rays (post extraction) from tooth #2 are from my wife and we believe there are still two retained roots (one appears to be the palatal root and the other the mesial root from a 3D scan done a couple months ago) due to apparent complications from an extraction just about 1 year ago. This was a very old and badly infected root canal tooth (second time re-treatment done 17 years ago). Her #2 extraction site was not bone grafted, but the sockets for teeth #3, #4, and #5 were and appear to be healing okay.

Also, the other x-rays are from a recent full mouth series of x-rays from my son (UR and UL areas). It appears there is an infection/cyst? above areas #2 or #3 in the UR area and extensive bone loss or a cyst above #14 in the UL area?). My son does not feel any pain directly in the teeth from either of these areas but is having some systemic symptoms.

Thank you

[Bryanna]

Hi Doitashi,

Thank you for posting the xrays.

The first xray of her upper right that you posted:

There appears to be 4 separate retained roots. I cannot tell you exactly what teeth they belong to because she's had several extractions and this xray is only of the posterior which does not offer any vision of what is more anterior. The farthest to the right retained root may be attached to a whole tooth. But since the xray is cut off in that exact spot, I cannot see if there is a whole tooth there or not.

The second xray that of her upper right:

This xray was obviously taken after root remnants were removed. The angulation of this xray is different than the first one and is not really conclusive whether or not there are retained root tips. But there doesn't appear to be any. The one thing that stands out to me is the area all the way to the right on this xray. Follow the jaw bone along the gum line from left to right. On the right there appears to be an opening in the bone which could be in communication with the sinus. It could also be just the angulation of the xray but by any chance has anyone remarked on that area?

The next three xrays are very light and many of the root tips are not captured in their entirety. So the diagnostic quality is not ideal on these films.
With that said, tooth #2 with the full coverage crown may have decay on the mesial area of the tooth at the crown margin. The mesial is on the right side of the tooth closest to tooth #3. The open or decayed area resembles a "bite" area out of the tooth. The angulation of the UL xray is not ideal and I am not comfortable commenting on it.

Bryanna








The area of teeth #4 and 5

Originally Posted by Doitashi62

Hi Bryanna,

Can you please take a look at these PA x-rays and let me know what you see? The recent PA x-rays (post extraction) from tooth #2 are from my wife and we believe there are still two retained roots (one appears to be the palatal root and the other the mesial root from a 3D scan done a couple months ago) due to apparent complications from an extraction just about 1 year ago. This was a very old and badly infected root canal tooth (second time re-treatment done 17 years ago). Her #2 extraction site was not bone grafted, but the sockets for teeth #3, #4, and #5 were and appear to be healing okay.

Also, the other x-rays are from a recent full mouth series of x-rays from my son (UR and UL areas). It appears there is an infection/cyst? above areas #2 or #3 in the UR area and extensive bone loss or a cyst above #14 in the UL area?). My son does not feel any pain directly in the teeth from either of these areas but is having some systemic symptoms.

Thank you

[Doitashi62]

[QUOTE=Bryanna;1191578]Hi Doitashi,

Thank you for posting the xrays.

The first xray of her upper right that you posted:

There appears to be 4 separate retained roots. I cannot tell you exactly what teeth they belong to because she's had several extractions and this xray is only of the posterior which does not offer any vision of what is more anterior. The farthest to the right retained root may be attached to a whole tooth. But since the xray is cut off in that exact spot, I cannot see if there is a whole tooth there or not.

The second xray that of her upper right:

This xray was obviously taken after root remnants were removed. The angulation of this xray is different than the first one and is not really conclusive whether or not there are retained root tips. But there doesn't appear to be any. The one thing that stands out to me is the area all the way to the right on this xray. Follow the jaw bone along the gum line from left to right. On the right there appears to be an opening in the bone which could be in communication with the sinus. It could also be just the angulation of the xray but by any chance has anyone remarked on that area?

The next three xrays are very light and many of the root tips are not captured in their entirety. So the diagnostic quality is not ideal on these films.
With that said, tooth #2 with the full coverage crown may have decay on the mesial area of the tooth at the crown margin. The mesial is on the right side of the tooth closest to tooth #3. The open or decayed area resembles a "bite" area out of the tooth. The angulation of the UL xray is not ideal and I am not comfortable commenting on it.

Hi Bryanna


Thank you for your time and providing input on this first set of x-rays. I actually do have a more recent PA x-ray (attached) that was only taken and centered on tooth #14 about one month ago that I hope may be a little clearer. Not sure if this is of better quality or angulation, but have had some increasing concerns specifically regarding the history of this tooth, restorations and previous deep decay.

Thanks again,

[Bryanna]

Hi Doitashi,

It's not your fault that the xrays are not as good as they should be. There is no excuse for this to happen but unfortunately it is pretty common.

This new xray was not positioned properly either but it does appear that tooth #14 may have something going on. By any chance did your son have an accident or get hit in that side of his mouth? Does he chew on hard candy? The reason I ask is because this tooth may be fractured. You mentioned there was some bone loss ... do you know which side of the tooth that was found? The mesial side (towards tooth #13) or the distal side (towards tooth #15)?

Tooth #14 as it appears on this xray is in close proximity, if not poking into, the sinus. Did the dentist discuss that with you?

Bryanna




Hi Bryanna


Thank you for your time and providing input on this first set of x-rays. I actually do have a more recent PA x-ray (attached) that was only taken and centered on tooth #14 about one month ago that I hope may be a little clearer. Not sure if this is of better quality or angulation, but have had some increasing concerns specifically regarding the history of this tooth, restorations and previous deep decay.

Thanks again,[/QUOTE]

[Doitashi62]

Thanks again Bryanna,

No history of accidents or getting hit in the mouth, but he did have a major filling (MO) on the side of #14 back in 2011. Also comparing panoramic x-rays from 2008 and 2013, it does appear there has been bone loss on the mesial area of #14 over just the past few years. Not sure if a possible fracture could have been there before the restoration or caused by the filling or after. But like you indicated, there does seem to be something going on there.

Our dentist did not mention anything about the sinus during another recent filling done on this tooth.

[Bryanna]

Doitashi,

On the xray that you posted of your son... the fillings in that xray do not appear to be deep. Did the dentist measure the pocket depths around this (and other) teeth? Did the dentist check the tooth with a frac finder for possible fracture?

Bryanna

Originally Posted by Doitashi62

Thanks again Bryanna,

No history of accidents or getting hit in the mouth, but he did have a major filling (MO) on the side of #14 back in 2011. Also comparing panoramic x-rays from 2008 and 2013, it does appear there has been bone loss on the mesial area of #14 over just the past few years. Not sure if a possible fracture could have been there before the restoration or caused by the filling or after. But like you indicated, there does seem to be something going on there.

Our dentist did not mention anything about the sinus during another recent filling done on this tooth.

[Doitashi62]

Bryanna,

Will have to check if the pocket depths were checked on his recent exam and cleaning. Did not know there was even such an instrument as a frac finder. I know that cracks/fractures have to be difficult at best to find (even with the best trained eye using regular x-rays or a 3d scan?). I thought the only way was for a specialist (oral surgeon/periodontist) to use a flap procedure to lift the gum away from the tooth/bone to verify. Thanks

[Bryanna]

Doitashi,

A Fracfinder or tooth slooth is a hard plastic instrument that resembles a small stick with a triangular or ridged surface on the one end. The dentist places that end into the patients mouth so that when the patient closes their teeth together, they bite down directly on this area of the stick. The stick is moved to different areas of the biting surface of the tooth each time the patient bites down on it. This can help diagnose certain fractures in teeth. Sometimes this test is inconclusive because as you mentioned, fractures can be difficult to diagnose depending on the location and depth of the fracture. However, it should be done whenever there is a suspicion of a fracture. I will attach a diagram of a Fracfinder.

Sometimes fractured teeth are not able to be diagnosed during a flap surgery because the fracture might not be displaced (jagged) or it could be so fine that it's not visible to the eye, or there may be several of them. Frequently the fracture is not diagnosed until the tooth is removed.

A 3D scan can be helpful in diagnosing a fracture of a tooth and/or the jaw bone as it offers a multi dimensional view of these areas compared to a 2 dimensional view with routine dental xrays.

Yearly (or more frequent) probing of the gum pockets should be done on every patient that is suspected of having any bone loss .... on every patient over 18 years of age... on any age patient suspected of having gum disease as well as those who have had gum disease.

A periodontal probe is a metal or plastic instrument that has a very thin 10mm ruler on one end. That ruler is gently placed in the gingival sulcus which is the space between the tooth and gum tissue. Six areas of the sulcus are measured on every tooth. Normal and healthy depths are 1-3 mm. Anything above the #3 is abnormal and needs to be evaluated for bacteria accumulation. Sometimes a person has very heavy and tenacious calculus built up along or below the gum line and this will interfere with obtaining accurate readings on the probe as the probe will not be able to get into those areas. Once that calculus is removed and the inflammation of the gum tissue calms down, then accurate probings can be done. I will attach a diagram of the periodontal probe.

Hope you find this information helpful.
Bryanna

Originally Posted by Doitashi62

Bryanna,

Will have to check if the pocket depths were checked on his recent exam and cleaning. Did not know there was even such an instrument as a frac finder. I know that cracks/fractures have to be difficult at best to find (even with the best trained eye using regular x-rays or a 3d scan?). I thought the only way was for a specialist (oral surgeon/periodontist) to use a flap procedure to lift the gum away from the tooth/bone to verify. Thanks