Dental Tribune United Kingdom Edition

Using CBCT to explore the amalgam pieces in the re- gion of #32 revealed scattered pieces entrapped under the oral mucosa outside the alveolar cortical plates, both lingual and buccal to tooth #32. It was also noted that the crown-to-root ra- tio of tooth #32 was much com- promised and the tooth should be considered for extraction. By using the i-CAT 3-D CBCT, precise 3-D software was employed to visualize the bone in three dimensions from different viewing angles (Fig. 2). It was revealed that some of the amalgam foreign body frag- ments were resting on the buc- cal side of the jaw bone on the right side, while other foreign fragments rested on the lingual side of the jaw bone under the lingual undercut (Figs. 3a–c). As no soft-tissue inflam- mation and/or bone remod- eling has occurred, following a professional dialogue between the restoring dentist and the oral surgeon, the amalgam foreign body fragments incidentally observed in this case were left intact, posing no medical risk and or interference in our pro- posed dental treatment plan for a dental implant in the re- gion of tooth #30. Nevertheless, continuous follow-up was strongly recommended. Conclusions Fortunately, following careful assessment, our patient did not experience symptoms associat- ed with the amalgam remnants embedded under the oral muco- sa, as has been reported in some cases in the literature.4 This case also demonstrates that restora- tive procedures and simultane- ous full-thickness flap elevation, especially those involving amal- gam restorations, ought to be re- considered. When the patient was seen by the oral surgeon for extraction of the adjacent tooth #31, the sur- rounding areas were evaluated as well. The patient wished to leave #32 alone, despite recom- mendations for extraction, so no further actions were taken at the time with regard to exploration of amalgam foreign bodies be- cause they were asymptomatic. This report also attempted to provide justification for the use of CBCT scans in order to visu- alize abnormalities from a 3-D perspective, ultimately facilitat- ing case management. While outcome assessments in this area of dentistry are dif- ficult, the authors believe that it is justified from a diagnostic per- spective, and what’s more, with renewed interest in mercury toxicity from amalgam fillings, the use of a CBCT scan to visual- ize amalgam foreign bodies and possible bone remodeling may offer invaluable information re- garding treatment protocols. DT Fig. 1 Fig. 2 Fig. 3 Fig. 4 References 1 Sumanth KN, Boaz K, Shetty NY. Glass embedded in labial mucosa for 20 years. Indian J Dent Res. 2008; 19(2):160–161. 2 Eyeson J, et al. Relationship between mercury levels in blood and urine and complaints of chronic mercury toxicity from amalgam restorations. 2010;208(4):E7; 162–163. 3 Kevin Trudeau. Panel Wants FDA to Examine Mercury Dental Fillings. www. ktradionetg Authors By Dov M. Almog, DMD; Samuel Melcer, DMD; Rachel Berley, DMD & Kenneth Cheng, DDS June 13-19, 2011United Kingdom Edition Tel: 01254 844 103 Call Prestige Medical today and ask for more details. Optima Autoclave 4 times the instrument processing power: • Reduced waiting time • Full colour display • Free installation, commissioning & training of your staff All this PLUS a full 2 year warranty. faster cycles With Flash Steam Technology® Optima: the ultimate vacuum autoclave - where cycle times are halved. E: sales@prestigemedical.co.uk · www.prestigemedical.co.uk See Optima at this year’s BDTA Dental Showcase