Take a good look at this panoramic image.  It is of a woman in her mid 70’s.  She has been a patient of mine of over twenty years.  She had many dental problems as a child and young adult that left her with an upper arch with much bridgework and a partial denture on her lower.  In the time she has been my patient her condition we have replaced some of the bridges and the lower denture but she has been relatively stable.

It is only recently that I was able to take a panoramic image on her and look at we found on the lower right hand side.  That is an impacted third molar with a huge cyst.  We did not even know it was there.  After informing her of the finding and its seriousness she scheduled an appointment with an oral surgeon in Manhattan.  Since knowing the location of the mandibular nerve is vital he took a CT scan of her jaw.  To his surprise he was not able to visualize it in the images so he sent her to another facility where they took a cone beam image.

Cone beam is the latest imaging technology in dentistry.  It allows for a total three dimensional image and is so detailed that it allows for visualization of bone thickness and detail within a fraction of a millimeter.   As no surprise the cone beam scan was able to locate the nerve but it revealed it in such a place that it was to make removing the tooth impossible.  It also revealed that as the cyst had expanded it had thinned the right jaw so much that it was at risk of fracturing.

The solution was to remove the cyst and the crown of the tooth while leaving the root in jaw.  This is called a Coronectomy.  This approach removes the pathology and allows the mandible to heal without risking never damage.

The best part is that the surgeon told her to go back and thank me for finding it as he believed that she was only a year or two at most away from a pathological jaw fracture.  The moral here is always have your routine screenings because sometimes what you find is far from routine.