Several years ago there was a remarkable case of a man whose routine wisdom tooth extraction turned out to be anything but routine. A typical panoramic X-ray showed that the roots of the tooth were close to the critical, main nerve that courses through the lower jaw and innervates the teeth, so extra care would be needed.
After proper loosening, the tooth should have simply popped out with a gentle tug. Astonishingly, it sprung right back into place, as though it were attached to a rubber band. A close, physical examination showed that the root had grown completely around the nerve, like a string through a Life Savers candy. Luckily, the nerve had not been severed, and a quick protocol change allowed the tooth to be removed without damaging the nerve.
How could this situation have been avoided? Although unavailable at the time, a dental cone beam radiograph would have alerted the dentist prior to surgery to the unique positioning of the tooth. Typical dental X-rays—bite wings, full mouth and panoramic—are two-dimensional (2D). The dental cone beam provides a three-dimensional (3D) view of the mouth and associated structures.
Using only conventional 2D X-rays in certain situations is similar to a used car buyer examining only the driver’s side of the car and then assuming that the passenger side is in the same condition. 3D cone beam is the view obtained by walking completely around, and looking below and above, the car.
Dental cone beams are currently recommended for implant surgery and planning, wisdom tooth extractions, root canal therapies and TMJ assessment, and patients needing them are often referred to specialists. A modern trend, however, involves dental offices adding dental cone beams to their standard practice, appreciating their value in diagnosing failing root canaled teeth, root fractures, sinus and jaw bone abnormalities and more.
As more dentists realize the undeniable truth in “you can’t see what you can’t see,” more patients will benefit from the 3D perspective offered by dental cone beams.
Dr. Hyo “Tony” Lim, DMD, is the founder of Dental Wellness Centre, 216 Mall Blvd., Ste. 11, King of Prussia. For more information, call 610-265-4485 or visit DentalWellnessCentre.com. January 2018