Do you remember the days back in dental school when we would look at a radiographs and say something like, “Well, we can’t tell for sure but that looks like nothing we should worry about”? If you’re like me and graduated a while back the answer is yes. If on the other hand you are a more recent graduate then maybe you are familiar with Cone Beam CTs (CBCT), which is a great tool. After all, when we make guesses about an unusual object on the traditional 2-D radiograph, we simply don’t know what we don’t know.
Take for example the lower right wisdom tooth area in this panoramic radiograph taken in my office.
For the most part this area appears to likely be nothing serious and just some osseous scarring from the removal of the lower left wisdom tooth. Furthermore, upon discussion with the patient, she recalled that she had been told this area was “nothing” in the past. Despite this I still recommended that we get an old panoramic film for comparison if possible and recommended a CBCT be taken as well. The recommendation for a CBCT was further solidified by consolation with my oral surgeon, Dr. Robert Wood, and review of a previous film showed that the location characteristics of the wisdom tooth that had been removed did not fully correspond with what we were seeing on the new radiograph.
Given this the patient elected to have a CBCT taken in my office to confirm that this area was nothing to be worried about. As you can see in the screen shot from the CBCT, this area was indeed not osseous scarring and was in fact something that needed to be biopsied.
I must say my oral surgeon and I, even after having used CBCTs for the last four years, were a bit shocked at how different things looked on the CBCT vs the panoramic image. As you can see even more clearly in these videos, the extent of the lesion is quite surprising.
John R. Carson, DDS, PC, Spear Visiting Faculty and Contributing Author www.johncarsondds.com