Definitive dental diagnosis using 3D X-rays

October 28, 2018 Alex Nguyen

Often time patients would present with a tooth that may feel unusual, uncomfortable, or slightly painful. However, traditional X-rays do not always show the exact problem due to the fact that bone morphology and root structures may overlap each other and create inaccurate images. Stitched together from precise individual slices of images, 3 Dimensional X-rays (Cone Beam Scans) provide very detailed images which can help clinicians see exactly what is going on with the questioned site.

The first X-ray below shows a tooth that may have something going on at the tip of the root, yet the information is limiting and non-diagnostic. The second X-ray below is an actual slice of a 3D Scan which shows definite lack of bone support on the front side of the tooth. The image also shows slow growing infection lesions that have been dissolving the bone around the roots of the tooth. The red arrows point to the problem area.

Based on the information from the 3D X-ray, this tooth cannot be saved because hanging on to it will allow further destruction of the jaw bone surrounding the tooth. Early detection of bone loss and infection can help make the treatments much more predictable, and 3D X-rays are now a very important part of our dental diagnostic tools.

Traditional X-ray showing possible problem at the end of the root.

A slice of a 3D X-ray showing definite bone loss and infection around the same tooth above.

Where to Start When it Comes to Implant Teeth

May 12, 2013 alexnguyen

When it comes to Implant teeth, the work should begin with proper diagnosis and treatment planning with the restorative dentist who will fabricate your final restorations. If the restorative dentist does not place the implants, he/she will coordinate with the surgeon so that the outcome of the treatment can be optimized for both esthetic and function. In the case below the patient went to an oral surgeon before coming to me for a consultation for crowns to be placed on the implants in her mouth. This is actually a reversed pattern of treatment. Sometimes the ideal final result cannot be achieved because the implants have been placed in the wrong position.

We will be gathering some detailed diagnostic records and studies to come up with a plan to restore these teeth, but there are obvious issues with the case.

In the X-ray you can see that Implant # 1 and # 2 were placed too close to each other. Here are the potential problems:

1. The crown for Implant # 1 may be much smaller than its ideal size.

2. The gum tissue between the teeth for Implant # 1 and Implant # 2 will not have any room to sustain a normal shape and healthy environment.

On the other hand, you can also see that implant # 2 and # 3 were placed too far from each other. Here are the potential problems:

1. The crowns between these 2 implants may appear unusually large/wide and may not fit the patient's smile esthetically.

2. It may also be impossible to create normally looking gum tissue between these two implant teeth.

Additionally, Implant # 3 was placed too close to the adjacent natural tooth. This may cause the natural root to resorb if indeed the threads of the implants have impinged on the ligaments and/or root of the natural tooth.

To ensure an optimal dental implant result, it is always recommended that the patient seek proper consultation with qualified clinicians prior to proceeding with the treatments.

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Alex Nguyen, DDS is a Saratoga Dentist who practices General Dentistry, Cosmetic, and Implant Dentistry. For over 20 years the practice has been serving the residents of Santa Clara County and San Francisco Bay Area.

Is a CT Scan Necessary for Dental Implant Treatments?

March 16, 2013 alexnguyen

In order to place an implant in the patient's jaw, we need to assess several criteria at the location of the planned implant. Some of the important factors may include: 1. The patient's bone height

2. The patient's bone width

3. The proximity to the nerves in the lower jaw

4. The proximity of the sinus cavity in the upper jaw

Using a 3D Cone Beam Scan (CT Scan) we can precisely analyze all of the above criteria and predetermine the exact size and location of the implant prior to the surgical placement.

Here is a screen capture of the planning process for two implants to replace two missing molars in our actual patient's lower jaw. The red line below the two planned implants is a nerve in the lower jaw. That nerve is often the limiting factor in the lower jaw where some implants for posterior teeth may be needed.

Proper use of technology helps ensure optimum results and safety of dental implant treatment.

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What to do when a crown or a bridge falls out?

April 30, 2011 alexnguyen

Crown and bridges are cemented or bonded in place. Although we can make them look exactly like the real teeth, they are not truly "permanently" attached to the teeth. They can de-bond (detach) from the teeth for many reasons, including heavy uncontrolled teeth grinding, chewing of strong sticky candies, etc... When a crown or a bridge falls out, it is best to try to:

1. Reinsert it into the exact place, EVEN if the tooth does not hurt.

2. Keep it in the exact place until you are able to see your dentist, EVEN if you cannot get to your dentist for an extended period of time.

3. Have your dentist evaluate the underlying tooth structure to make sure that decay is not the cause of the detachment.

Do not use glues such as Crazy Glue. Household glues do not work, and they will distort the fit between the tooth and the restorations.

Do not leave them out of the mouth: The adjacent teeth can easily move into the space where the crown or the bridge was occupying. When this happens, the restoration will no longer fit and the only solution may be to replace it with a new one.

As always, a little common sense will save you and your dentist both time and money.

Thanks again for reading my blog.

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Smiles of Regret. Who Do You Choose to Restore Your Teeth?

November 19, 2010 alexnguyen

Over the years I have had the opportunity to see cases of patients who came to me for initial consultation but ended up elsewhere for the completion of their dental work. Here are some cases where the patients returned to me a few years later to express their discontent and to complain about problems with their teeth. These are smiles of regret. Who do you choose to restore your teeth? Sometimes people will make their choices based on beautiful advertisements that they see. Sometimes the choice may be based on a price tag that may fit their budget at that particular moment. The key to remember is that an unsuccessful restorative case may eventually cost you more time and money to have the work redone.

CASE I: Excess cement materials left under the gum line and around every single restoration. This caused chronic inflammation of the gum and bone loss over time. The patient was also unhappy with the esthetic result.

CASE II: Restorations done without regards to the foundation of this patient's bite. After 3 years, there are gaps between teeth, crowns with open margins, crowns that are breaking away, and discomfort on chewing. There are even teeth left unrestored. The patient was also unhappy with the esthetic result.

Images of actual patients of Alex Nguyen, DDS are Copyrighted and Digitally Embedded to track Unauthorized Use

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