Monday, September 10, 2012
There have been plenty of cases in which I found a Cone Beam CT to be advantageous to traditional two-dimensional images. Recently, I wrote an article showing a case with a huge periodontal pocket that was completely invisible outside of the 3D scan. Once again this past week we had a case that showed not only how powerful cone beam scans can be for diagnosis, but how we were able to avoid a scary and expensive situation for the patient.
This patient was a thirty-five year old female. She is completely healthy, and has had minimal dental work in the past. She was in for a checkup and cleaning, and was due for a full mouth set of x-rays. In the last few years, our “FMX” has turned into a panoramic x-ray, and a set of bitewing x-rays. Both are digital, save a ton of time and allow for significantly reduced exposure to radiation for the patient. At the ramus of the right mandible, we noticed some small defined radiopaque objects.
As it happens in every office, we had neglected to have her take her earrings out, and we wanted to confirm that there was no interference or scatter from the metal. We had her remove the earrings and we took another digital panoramic x-ray. There was also a question of whether or not there were slight radiolucent areas around the small objects.
As expected, the radiopaque objects were still there, and appeared to be in the same position as the previous scan. Normally, we would have had to either refer to an oral surgeon, or an ENT. We definitely would have had to inform the patient of our worries over some kind of neoplasm or cyst. The visit to another office would have cost more time and money. After further consultations, she would have gone to our local imaging center for a traditional, high-radiation, high-cost CT scan.
Instead, we had her step in front of our Cone Beam CT. Three minutes later we were able to visualize the three dimensional picture you can see in the movie below. Take a look at the small dots just medial to the right ramus.
What we were looking at were calcifications in the patient’s tonsils, or tonsilloliths. They are benign, and the worst thing they can cause is a bit of a sore throat and bad breath. Here also is an axial view showing the positioning of the stones.
This is why three-dimensional imaging is so powerful. Traditional 2-D imaging smashes all layers together without being able to see the whole picture. That’s why it was so unclear whether or not we were looking at mixed radiolucencies. Plus, we were able to reassure the patient that all was fine without having to send her into a weekend of worry with significant costs to come.
Have you had similar experiences with your cone beam CT machine? Drop a comment below or email me some pics. We could potentially turn it into another case study on Dentalcompare.