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A 50-year-old patient with extended soft tissue swelling around teeth #43 and #44 presented at my practice without pain and irritability (Fig.1 and 2).
An extraoral image was captured with the Carestream Dental CS 8100 3D. The panoramic image revealed multiple coronal and apical pathological findings (Fig. 3).
Using the CS 8100 3D, a CBCT volume was taken with a 150-micron resolution for further diagnostics using the FDK reconstruction, as well as the new CS MAR (metal artifact reduction) algorithm by Carestream Dental, which greatly increases the spectrum of diagnostic possibilities.
When comparing the panoramic images extracted from the 3D scan (Fig. 4 and 5), the image with CS MAR (Fig. 5) applied showed significantly lower artifacts caused by implants, fillings and dental crowns. Various pathological findings, such as apical brightening at teeth #15, #26, #37 and #47; coronal brightening at teeth #15 and #45; and osteolysis at #15, #43 and #44, were easily identifiable. For confirmation of the diagnosis, the transverse and horizontal planes were also examined in both FDK and with CS MAR applied (Figs. 6-7).
In this case, a polycystic amelobalstom at #43 and #44 was suspected. The displaced expulsion of the bone and degradation of the bone and teeth where the tumor had penetrated them were all typical clinical characteristics.
When comparing the two reconstructions, the CS MAR reconstruction clearly revealed radicular processes in teeth #37 and #47; the osteolysis at #43 and #44; a mesioperiodontal lightening; as well as a distal fracture line at tooth #45 (Fig. 9).
Using Carestream Dental’s CS MAR in the CS 3D Imaging software allows for more advanced diagnostics, while decreasing the chance of misidentifying artifacts with moiré patterns and motion artifacts.
For example, several implants in the FDK reconstruction caused a strip-like hardening and extinguishing artifacts that made it hard to make a diagnosis. When applying CS MAR, the hardening and artifacts were significantly reduced.
Teeth #15, #37, #45 and #47 were extracted. Based on the main finding of the CBCT volume—the space-demanding ostelysis with a suspected tumor at #43 and #44—a fine-tissue examination (histological clarification) of the tumorous tissue was conducted to confirm the initial diagnosis. The tumor was then surgically treated. After the tumor was removed, the bone defect was reconstructed.
Current literature shows a recurrence rate of up to 30 percent for these types of tumors. Therefore, the patient will be recalled and observed for several years.
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Dr. Faust successfully completed an apprenticeship as a dental technician and studied at the University of Hamburg, where he also received his doctorate in dental studies with a focus on fully ceramic restorations. Dr. Faust is particularly interested in radiological imaging using his Carestream Dental imaging system. He has also written for and been published by the German Medical Publishers.