PBL Sample Case Day 2, Page 1


Day 2

The results of the panoramic radiograph reveal the following:

Mr. Helmke is missing teeth #1-16, 18, 19, 21, 29, 30 and 31.  Teeth #17, 20, 22, 28 and 32 have full crowns.  The shape and taper of the crowns suggest the patient was fitted for a removable partial denture.  Tooth #22 have been endodontically treated.  And the treatment appears to be successful.  There is evidence of incisal wear on the mandibular anterior teeth, possible form an opposing maxillary denture.  Tooth #23 has an opacity consistent with a dental restoration on the distal surface, and there is a round radiolucency approximately 2-3 mm in diameter just coronal to the alveolar crest on the facial or lingual aspect of #23.  This radiolucency is consistent with a nonopaque dental restoration, caries or represents superimposition of a portion of the cervical spine.  A final diagnosis should be made with an oral examination.

There is generalized mild to moderate horizontal alveolar bone loss in the mandibular arch with localized vertical defects of 1-2 mm on the mesial tooth #17, the distal of #20, the mesial and distal of #28, and the mesial of #32.  There has been resorption of the maxillary alveolar bone to the point that the floors of the maxillary sinuses coincide with the alveolar crests.

There is a well-defined, somewhat dome-shaped opacity approximately 1.5 cm X 3 cm on the floor of the nasal aspect of the right maxillary sinus.  It has not resorbed or displaced any adjacent structures.  This opacity is consistent with a hyperplastic response of the mucosa to irritation of with a mucous retention cyst.  Residual lamina dura remains in the extraction sites of teeth #18 and 31, and there is a well-defined opacity, approximately 1 cm X 0.5 cm, with irregular borders and no radiolucent rim in the apical aspect of the extraction site of tooth #31.  This opacity is consistent with a diagnosis of sclerotic bone or osteosclerosis.  Remaining structures are normal.

Day 2, Page 2