What Does This X-ray Report Indicate?

Posted on Sat, 17 Jun 2017

Question: 1. please see the attached xray - can the teeth be saved or do they need to be extracted. they are loose and are in discomfort. could periodontal procedures and bone grafting fix the problems?

2. is it possible to get dental implants that match the shape and size of the extracted teeth?

Answered by Dr. Honey Arora (32 minutes later)

Brief Answer:
Please provide more details..

Detailed Answer:
Hi..
Thanks for the query..

As far as the x ray is concerned that is approximately more than one third of the roots that has bone loss.
But as you have written that you have consulted a Dentist, can you please tell me that what is the grade of mobility that you are told.
Is is Grade 1,2 or3?
It is an important criteria to decide whether tooth can last for sometime or not.

Please revert back with answers..

As far as implant is concerned, yes implant can be done for appropriate shape and size of natural teeth, so that is not an issue..

Please tell me the grade of mobility if you know..

Regards.

Above answer was peer-reviewed by : Dr. Vaishalee Punj

Follow up: Dr. Honey Arora (8 hours later)

grade 2
Can bone grafting be done to help?

Answered by Dr. Honey Arora (10 minutes later)

Brief Answer:
Better to go for extraction followed by implants.

Detailed Answer:
Hi..
Well bone grafts can help to some extent but teeth has to be splinted to make them firm in their position.

But still the results can be questionable.

So it is better to get the teeth extracted and go ahead for implants..

Hope this helps..
Regards..

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Honey Arora (45 minutes later)

why do you think it is better to get the teeth extracted?

There is significant attachment loss -- why is the teeth loose? could the ligiments just be streched? there has been significant attachment loss this year. can they rebuild the bone ?

Answered by Dr. Honey Arora (10 minutes later)

Brief Answer:
Yes there is significant attachment loss due to bone resorption.

Detailed Answer:
Hi..
There is significant bone loss due to which the teeth have become lose.
As I told before you can go for bone grafting but it would need proper splinting of the loose teeth and maintenance of meticulous oral hygiene..
So of you wish to keep the teeth then you can go for bone grafting..

It is not just stretched ligaments but clear case of bone resorption..

Please revert back for more queries..

Regards..

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Honey Arora (1 hour later)

How soon does bone grafting need to be done . If there is no bleeding could it be anug?

Is it possible to do the whole mouth at once?

If the bone grafting is successful can the teeth become stable (no mobility)

If the tooth needs to be extracted due to gum disease, which causes bone loss, the situation only worsens. Your body is trying to “self-extract” your tooth by dissolving the surrounding bone and making it loose.

Is the above something to worry about

Also, do you recommend getting a mold done of the real teeth to get the implants and crowns made exactly the same?

what is the best way to have the crowns and implants look exactly the same as the real teeth. what are the most expensive type of implant

and can the crowns and implants be put in at the same time

also can the teeth tighten up on there own? there is 4mm of recession

Answered by Dr. Honey Arora (9 hours later)

Brief Answer:
Teeth will not tighten on their own..

Detailed Answer:
Hi..
Here are the answers.

It does not look like ANUG, however a clinical examination can give a better picture.
You can get a clinical examination done and after a thorough Scaling and root planing with proper antibiotic prophylaxis, the bone grafting can be done.
No, grafting can be done quadrant wise and not completely at one time.
Yes, mobility can reduce with proper grafting and further care.
Body is not trying to self extract, it is infection that causes loss of attachment and bone resorption, it is.localised so nothing to worry as it can be very well treated.
There are fixed sizes and guidelines for fabricating artificial teeth..
So do not worry as teeth can be very much made of appropriate shape and size.
Yes, immediate loading implants can be done in which both implant and crown is dived at same time.
No teeth will not tighten on its own..

Please revert back for more queries..

Hope this information helps..

Regards.

Above answer was peer-reviewed by : Dr. Nagamani Ng

Follow up: Dr. Honey Arora (14 minutes later)

Can bone grafting and dental implants be done at the same time?

Could you also review the attached images - what is the lesion on the tongue - it gets bigger and smaller depending on the day. is it cancer?

also, how urgent do the bone grafts need to be done?

if you were the patient in the x-rays, what would you do? would you get the teeth extracted?>

would you recommend Growth factors. Platelet derived growth factor and the bone morphogenetic proteins in this case>? what about
14. Bone loss is the major concern - Whhich of the following treatments would I be good candidate for:
a) Bone grafting. This procedure is performed when periodontitis has destroyed the bone surrounding your tooth root. The graft may be composed of small fragments of your own bone, or the bone may be synthetic or donated. The bone graft helps prevent tooth loss by holding your tooth in place. It also serves as a platform for the regrowth of natural bone.
b) Guided tissue regeneration. This allows the regrowth of bone that was destroyed by bacteria. In one approach, your dentist places a special piece of biocompatible fabric between existing bone and your tooth. The material prevents unwanted tissue from entering the healing area, allowing bone to grow back instead.
c) Enamel matrix derivative application. Another technique involves applying a special gel to a diseased tooth root. This gel contains the same proteins found in developing tooth enamel and stimulates the growth of healthy bone and tissue

Answered by Dr. Honey Arora (23 minutes later)

Brief Answer:
I would still go for implants.

Detailed Answer:
Hi..
Yes bone grafting and implant placement can be done at the same time if there is very little need for graft placement.
But in your case I would suggest to go for grafting first and let the bone regenerate and then proceed for implant so that you have ample of bone support to hold the implant tightly..
GTR can help however it needs a meticulous oral hygiene and an expert hand to do it..
So it can even be an individual decision to proceed..

For the white patch over your tongue, can you tell me that for how long is it present?
-Is it scraped if you try?
-Is it painful?
-Does it come and go?
-Does it increase and decrease in size or is stable?

Please write back..

Regards.

Above answer was peer-reviewed by : Dr. Nagamani Ng

Follow up: Dr. Honey Arora (11 minutes later)

why would you go for implants if things could help save your teeth>

not painful
it does come and go
it does increase and decrease in size

Answered by Dr. Honey Arora (5 minutes later)

Brief Answer:
It looks like fungal Infection.

Detailed Answer:
Hi..
I already told you, that it is individual decision and I am preferring implant as complete bone regeneration is very less commonly seen..
And another thing is the treatment plan can vary from Dentist to dentist.
But yes, if you are very specific about keeping the teeth you can go for GTR.

The white coating appears to be fungal infection or Oral Thrush.
You can start gargling with Nystatin mouthwash and suck Clotrimazole lozenges.
Take plenty of probiotics like Yogurt.
See for 15 days if it resolve completely and revert back..

Please write back for more queries..

Regards..

Above answer was peer-reviewed by : Dr. Nagamani Ng

Follow up: Dr. Honey Arora (1 hour later)

can you tell by the xray that we sent if there is any cavities or decay n the tooth? it is in discomfort (constant)

also I will attach pictures. can you please let us know if there is decay or cavities in the tooth?

Answered by Dr. Honey Arora (4 minutes later)

Brief Answer:
Please send clear picture.

Detailed Answer:
Hi..
Both the images you have sent are blurred and not appropriate for diagnosis..

Please upload clear images..

Regards.

Above answer was peer-reviewed by : Dr. Remy Koshy

Follow up: Dr. Honey Arora (39 minutes later)

see attached

are root cavities or decay visabile on xrays

Answered by Dr. Honey Arora (37 minutes later)

Brief Answer:
Root caries not visible..

Detailed Answer:
Hi..
I just have one x ray that you sent in the beginning and in that I do not see any root caries but your molar teeth have fillings..
And the first molar has filling approximating the nerves that can be a cause of sensitivity and pain.

Can you tell me which teeth are sensitive or you are in discomfort with?
Is it just discomfort or pain?

Please revert back..

Regards.

Above answer was peer-reviewed by : Dr. Remy Koshy

Follow up: Dr. Honey Arora (2 hours later)

could you please look at images :

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• IMG_0007.JPG

• IMG_0007.JPG

Please let me know if thre is a symptom of anug in the pictures

Answered by Dr. Honey Arora (3 minutes later)

Brief Answer:
These images are completely blurred.

Detailed Answer:
Hi..
I have already evaluated these pictures and as I told you before the images are blurred to the extent that they are not appropriate for any observation and diagnosis..
Please upload clear images so that I can give you an appropriate advise..

Regards.

Above answer was peer-reviewed by : Dr. Vaishalee Punj

Follow up: Dr. Honey Arora (11 hours later)

It feels like there is an infection / bad taste in the side of the mouth where the X-ray is . Fees like it should be sucked out . What is going on?

But I've been told there is no active gum infection periodontal disease

can the teeth in the xray be saved they are mobility class 2

Answered by Dr. Honey Arora (5 hours later)

Brief Answer:
The symptoms are signs of infection only..

Detailed Answer:
Bad taste and sucked out feeling is due to Infection only..
Many a times chronic infections does not show acute signs of Infection but Infection is always present..
Due to bone loss there must be pocket formation between the gum and tooth and it gives this sucked out feeling..
You can try to save the teeth with above discussed treatment like GTR or bone graft..

Regards..

Above answer was peer-reviewed by : Dr. Remy Koshy

Follow up: Dr. Honey Arora (1 hour later)

what do you mean infection? what type of infection

is it aggressive periodontitis?

I met with a periodontist 1.5 weeks ago and they said there is no gum or periodontal disease?

Answered by Dr. Honey Arora (2 minutes later)

Brief Answer:
No.

Detailed Answer:
No, It is not aggressive periodontitis.
It looks like chronic periodontitis.
If the Periodontist said there is no gum infection or periodontal disease then what reason did he tell you for the bone loss??

Regards.

Above answer was peer-reviewed by : Dr. Remy Koshy

Follow up: Dr. Honey Arora (2 hours later)

what about the pain in the area of the mouth? is this due to an infection or a loose tooth?

Answered by Dr. Honey Arora (19 minutes later)

Brief Answer:
Due to loose tooth.

Detailed Answer:
Hi..
Pain is due to loose tooth only..
Loosening of teeth is due to bone resorption that inturn is due to infection..

Please write back for further queries.
I will be happy to help..

Regards..

Above answer was peer-reviewed by : Dr. Kampana

Follow up: Dr. Honey Arora (42 minutes later)

is there any chance it is trench mouth?

Answered by Dr. Honey Arora (7 minutes later)

Brief Answer:
Can you please send images of your teeth and gums.

Detailed Answer:
Hi..
From your explanation and after viewing your x ray it does not look like Trench mouth that is just another name for ANUG.

But if you send me clear images of your teeth and gums I will guide you more appropriately.
But from the discussion till now the symptoms are not due to Trench mouth.

Regards.

Above answer was peer-reviewed by : Dr. Remy Koshy

Follow up: Dr. Honey Arora (6 hours later)

see attached - gums have improved since this picture

also
I had bonding done on 6 upper teeth that I terribly regret. the dentist took a lot of the natural tooth before doing the bonding. I am curious if the bonding can be taken off and the exact shape of the original tooth restored if necessary

Answered by Dr. Honey Arora (26 minutes later)

Brief Answer:
Your gums looks fine.

Detailed Answer:
Hi..
Your gums in your image are looking fine and no signs of ANUG or Aggressive Periodontitis are there..
Although due to previous Infection or chronic infection I can see gum recession..
You can get treatment done to save these teeth..

As far as bonding is concerned, as the tooth structure is removed, so without artificial replacement like filling or capping teeth cannot be bought in original shape and size..

Hope this helps..

Regards.

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Honey Arora (19 hours later)

2017-05-24

Thank you for your answers so far. Could you please help me with the following questions? Here are a list of questions that I have for a periodontist (could you please help me by letting me know if I need to ask further questions).

Priority
1. What treatment is needed
1.     I was told by a periodontist that I need bone grafting to save my teeth. Could you do this for me? If so, when does it need be done by?
2.     Why are my teeth loose? Can a periodontist rebuild the bone for me? I am having pain in the location of the loose teeth

3.     What is my diagnosis? Could you please provide a treatment plan for me? What are treatment options could you please offer me?
4.     What would be the top of the line / best treatment options available?
5.     Can you repair my gum recession for me without using palatal tissue? Can you reconstruct my periodontal tissues? One option I received PRP with a collagen membrane and bovine bone graft in each area of my mouth.
6.     Do I have active gum disease? If so, can you slow down progression of my disease
7.     Would you recommend Advanced regenerative technologies on me – for example new barrier-membrane techniques, cell-growth-stimulating proteins or gene-delivery applications? have entered the clinical arena.
8.      Do I need to reduce coffee intake?
9.     Can my bite be fixed? Would this include corrective jaw surgery? I already
10.     Can you perform imaging to keep track of the progression of my bone loss,etc? could you please describe options for me?
11.     Could I still obtain orthodontic treatment - I doubt it but I read sometimes it could have a positive impact on periodontal treatment

Other
12.     Why are my teeth loose? Can you rebuild the bone for me?
13.     What are treatment options could you please offer me?
14.     What is my diagnosis? Could you please provide a treatment plan for me?
15.     What would be the top of the line / best treatment options available?
16.     Can you repair my gum recession for me without using palatal tissue? One option I received was PRP with a collagen membrane and bovine bone graft in each area of my mouth. What options do I have?
17.     If I need dental implant sin the future. Is it possible to get each individual tooth to look the same size and shape as my current teeth? If so, can you prepare molds of my teeth and a 3D CAT scan for me? What would you recommend?
18.     Do I have Acute necrotizing ulcerative gingivitis or any type of active gum disease?
19.     Will drinking coffee increase my bone loss?
20.     Should I be taking doxycycline?
21.     I sometimes feel like I need to suck food out the my upper right portion of my teeth. Is there an infection there?
22.     I’ve read about some of the cases at the University of Michigan Dentistry and some of your research.
23.     Do you recommend Platelet Dervived Growth Factor or Emdogain
24.     old male patient was conducted, to evaluate the bone regeneration using collagen sponge with metronidazole 4.5 mg in horizontal defect. From the presented case, it can be concluded that collagen sponge with metronidazole is clinically and radiographically efficacious in the treatment of a horizontal bone defect. Thus, signifying its role as a regenerative material in the treatment of horizontal bone defects
25.     Can you something to relax me during surgeries? Sometimes back gets uncomfortable and I have trouble sleeping the day before surgery.

Answered by Dr. Honey Arora (6 minutes later)

Brief Answer:
Just ask about the outcome and longevity of treatment results.

Detailed Answer:
Hi..
Your questions are more than sufficient and hopefully your periodontist can answer all..
Whichever treatment you decide, just discuss about the outcome or result of the same, that is how long will the teeth stay after the treatment..

Regards.

Above answer was peer-reviewed by : Dr. Vaishalee Punj

Follow up: Dr. Honey Arora (8 hours later)

Why do Is there a food taste (sometimes) like peanut butter in the area of The mouth in the X-ray ?

also, if the pockets are 3-4mm and the gum recession is 2mm or 3mm does that mean the pocket is really 6 mm?

is that indicative of gum disease

for dental implants can each tooth have its own dental implant which has the same size and shape as the previous natural tooth

Answered by Dr. Honey Arora (9 hours later)

Brief Answer:
Infection is the cause.

Detailed Answer:
Hi.
Yes, bad taste is due to Infection and there is a possibility of discharge of infectious fluid or accumulation of food debris.
Pocket depth depends on the reference point selected, whether it is cervical line or gum margin.
But in either case it is indicating Periodontal disease.
Implant number depends on whether the implant is for single tooth or multiple teeth..
If it is for single tooth then one implant can be done.
If there are multiple implants needed adjacent to each other then bridge can be placed..

Hope this helps..

Above answer was peer-reviewed by : Dr. Nagamani Ng

Follow up: Dr. Honey Arora (3 hours later)

I don't like on a bridge how the teeth are fused together. can I get individual implants for each tooth. can I also send you some xrays to determine if you recommend extracting the teeth or not? pls see attached

Answered by Dr. Honey Arora (18 minutes later)

Brief Answer:
The teeth in x ray can be saved.

Detailed Answer:
Hi..
Thanks for the query..

The teeth in x ray are still in position to be saved..
Get a deep scaling done followed by maintaining a good oral hygiene..
Yes, you can go for individual implants if you do not wish to get a bridge..

Please revert back for more queries..

Regards..

Above answer was peer-reviewed by : Dr. Kampana

Follow up: Dr. Honey Arora (6 hours later)

can the bone be rebuilt?

Answered by Dr. Honey Arora (22 minutes later)

Brief Answer:
Bone can be regenerated with the help of bone grafting.

Detailed Answer:
Bone cannot be rebuilt but it can be induced to regenerate with the help of bone grafting procedure..

Hope this helps..

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Honey Arora (10 hours later)

if there is no bleeding does that mean the patient doesn't have Acute Necrotizing Ulcerative Gingivitis ?

Answered by Dr. Honey Arora (1 hour later)

Brief Answer:
Your symptoms are not consistent with ANUG.

Detailed Answer:
Hi..
Acute Necrotising Ulcerative Gingivitis has very aggressive symptoms and spread too fast..
However bleeding of gums is not always due to ANUG.
So if you don't have bleeding then probably you do not have inflammation and severe Infection..

Regards.

Above answer was peer-reviewed by : Dr. Remy Koshy

Follow up: Dr. Honey Arora (2 hours later)

I hhave 2 more questions:

1. I've attached 2 X-rays - is there increased bone loss?
2. Also are the loose teeth (molars) that we were discussing going to need to be extracted soon? I do not want to leave them in that condition.

Answered by Dr. Honey Arora (6 minutes later)

Brief Answer:
When are these x rays taken.

Detailed Answer:
Hi..
Can you tell me exactly when these x rays were taken.
One is labelled as 2016 and other as 2017?
Is it correct?
Yes, there is increased bone loss..

Regards

Above answer was peer-reviewed by : Dr. Kampana

Follow up: Dr. Honey Arora (2 hours later)

Does severe gum recession need to be treated? what happens if it is all over your mouth?

Answered by Dr. Honey Arora (3 minutes later)

Brief Answer:
Yes, gum recession needs treatment..

Detailed Answer:
Hi.

Yes gum recession definitely needs to be treated to prevent the teeth from falling..
So you should start taking treatment for the same..

Regards.

Above answer was peer-reviewed by : Dr. Remy Koshy

Follow up: Dr. Honey Arora (22 hours later)

what do you mean "teeth from falling"?
is the bone loss getting worse because of the gum recession?

Answered by Dr. Honey Arora (39 minutes later)

Brief Answer:
Bone loss will progress due to Infection.

Detailed Answer:
Hi..
Yes, if not treated then the gum recession and bone loss will progress causing further loosening of teeth that can fall in future..

Hope this helps..

Above answer was peer-reviewed by : Dr. Remy Koshy

Follow up: Dr. Honey Arora (47 minutes later)

why would a periodontist tell me not to floss a certain area with a lot of gum recession?

it was in the area of the loose teeth in the xray that I shown you. when I floss they become looser

Answered by Dr. Honey Arora (6 minutes later)

Brief Answer:
To avoid trauma to teeth.

Detailed Answer:
Hi..
You are asked not to floss to avoid pushing the tartar and plaque towards the gums and also avoid pressure over the teeth so that they do not become looser..

Hope this helps..

Above answer was peer-reviewed by : Dr. Nagamani Ng

Follow up: Dr. Honey Arora (45 minutes later)

should a patient be brushing their gums?

Answered by Dr. Honey Arora (48 minutes later)

Brief Answer:
No

Detailed Answer:
Hi.
No patient should not brush their gums..

Do you use mouthwash or are you taking any medication currently for the infection?

Regards..

Above answer was peer-reviewed by : Dr. Nagamani Ng

Follow up: Dr. Honey Arora (20 hours later)

please see attached
the gums are in almost constant pain (too filled up with food I think might be the problem) what do you recommend?

Answered by Dr. Honey Arora (3 minutes later)

Brief Answer:
Get extraction done.

Detailed Answer:
Hi..
I have seen the image and I do not think these teeth can be saved..
So it is better to get them extracted.
For now take painkillers like Ibuprofen and do salt water rinses..

Hope this helps..

Regards.

Above answer was peer-reviewed by : Dr. Vaishalee Punj

Follow up: Dr. Honey Arora (5 minutes later)

is there any chance at guided tissue regeneration

Answered by Dr. Honey Arora (1 minute later)

Brief Answer:
Less possible

Detailed Answer:
Hi..
There are almost negligible chances of GTR.
The recession is almost over 2/3rd of the roots.
So extraction is a better option .

Regards..

Above answer was peer-reviewed by : Dr. Vaishalee Punj

Follow up: Dr. Honey Arora (15 minutes later)

do you think all of the teeth in the picture need to be extracted

Answered by Dr. Honey Arora (6 minutes later)

Brief Answer:
No the last two teeth.

Detailed Answer:
Hi..
The last two teeth should be extracted.
Rest can be attempted to be saved..

Regards
.

Above answer was peer-reviewed by : Dr. Vaishalee Punj

Follow up: Dr. Honey Arora (5 hours later)

who extracts the teeth? a dentist?

Answered by Dr. Honey Arora (3 minutes later)

Brief Answer:
Yes

Detailed Answer:
Yes a Dentist will extract the teeth..

Please revert back for more queries..

Regards..

Note: Find out which dental treatment will work best for your teeth. Ask here.

Above answer was peer-reviewed by : Dr. Prasad