This past week a patient came to see me for a second opinion on her dental implant treatment. She brought me a copy of the xray below, and asked me if I could advise her on whether or not she should do 1 or 2 implants to replace the teeth indicated by the green arrows. She wanted to find out which of the following treatment options is better:

Note: After this xray was taken, tooth (10) was extracted and a bone graft was done for this area by an oral surgeon. In other words, tooth (10) currently is missing.

Plan A: Extract the teeth labeled (8) and (9); place an implant at (8); do a bridge from position (8) to (11).

Plan B: Keep teeth (8) and (9) as is, and simply attach a new tooth to the implant crown (11) to replace missing tooth (10).

Unfortunately, I could not answer her questions because the copy of the xray given to her was not useable. Printed on regular white printer paper, the xray was dark and fuzzy. I could not clearly see the bone level at the location of these teeth. In fact, to identify the health of the existing teeth, other types of xrays would be necessary to have for our evaluation of the current condition. In this case, xrays called periapicals (often abbreviated PA) would then allow us to not only evaluate the bone but also the root structure and internal condition of these teeth. For example, if the integrity of teeth (8) and (9) is normal, and a successful bone graft was done for (10), then why would we want to remove 2 additional fully functional teeth?

We simply did not have enough information to determine an accurate evaluation based on this xray alone. Furthermore, when it comes to implant treatment, accurate studies of this patient's bite also would be necessary in order to complete a diagnosis and treatment plan.

When asking for copies of your xrays, please remember to ask your dentist to provide you with quality copies. This most basic diagnostic tool must be clear and readable.