Wisdom teeth surgery

[Firas]

First Hello to every one and thank you for this nice forum.

I have a big problem, my wisdom teeth is in a horizontal orientation, it was ok till a part of my teeth was broken and now it became not comfortable, hard to clean and smelling bad, so I thought if it is possible to remove it without a risk I'm just ready to do that
about tow months a go I visited a doctor, after checking my X-ray film he said to me that there is a risk to damage the nerve and that will make me losing the sensation with the right part of my downer lip and may be that will stay forever ,

I felt so scared of course and I left the hospital till I realized that I have to try more

I visited a different hospital tow days a go
and he said totally different thing,
he said to me that my surgery will be in 1/7/2015 and when I asked him is it possible to damage the nerve he said to me no don't worry. that made me feeling happy a bit but at the same time I started feeling nervous, should I trust him and believe what he said ?
that is why I thought to ask doctors and specialist in this forum to tell me the chance of the nerve damage in my situation
please dear specialists and doctors check my X-ray and tell me is the position of the nerve and the teeth really can damage the nerve during the surgery ?

Sincerely
Firas from Turkey

 

[Zuri Barniv]

Unfortunately, the risk of nerve injury on the lower right tooth is very real as the tooth intersects the nerve in the x-ray. That does not mean it intersects it in reality. What I mean is that you are looking at a 3D object in 2D. The nerve may be very close and your risk is very high or the nerve is farther away and you will probably be fine. There is no way to tell with this x-ray. In the United States, the standard of care dictates that you get a 3D x-ray (cone beam x-ray) in order to see what is really going on there. Without that, all any dentist can tell you is the risk exists and that the risk is real (not theoretical). I would insist on a 3D x-ray and I would only see a surgeon who has experience with these issues and agrees a 3D x-ray is needed here. I would not go to a surgeon just because he tells you it will be OK.

 

[Firas]

thank you very much dear Barniv for the clear answer,
so you think that I really need 3D X ray I hop they can do it in Turkey I will visit the dentist again and asking for a 3D X Ray
please don't hesitate to tell me in case of nerve damage will I stay for the rest of my life without feeling in the right down part of my lip ?

what if they will tell me that they don't use 3D X ray in Turkey ? what I have to do ?
there is no chance to know the real risk from just this panoramic picture ?

 

[Zuri Barniv]

Yes, I really think you need a 3D (cone beam) x-ray. Nerve damage could cause you to lose all sensation in your lip and chin on the lower right side, but it could also cause pain to occur there, which is actually worse than being numb. The risk is there. You cannot know the risk from just a 2D panoramic x-ray. There is a good chance your dentist will tell you they don't do 3D x-rays even though I know for sure they have the machines in Turkey. If you are in Istanbul, Ankara or other big city, I would be surprised if you can't find a surgeon who has experience with this and access to such a machine. In the USA, it costs about $300 to take this x-ray.

Read this for more information on cone beams x-rays in Turkey: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3528136/

 

[Firas]

thank you very much for your Answer dear,
now I'm worrying more then any time before,
I can't imagine the horrible causes that can happen to me in case of a bad surgery
I'm living in Eskisehir but I will go to a big city to save my self

actually the doctor did a different film for me, but when I went back home I checked the file I found he filmed the wrong place
I will share the picture with you

I will find a way to get a 3D Xray before the surgery or I will cancel the meeting with that doctor
really I appreciate every advice
thank you very much
as soon I will get the 3D X ray I will share it with you

 

[Zuri Barniv]

By the way, you do have a very deep cavity on your lower left molar 3rd tooth from the back and a moderate cavity on the tooth behind that one. You will probably need a root canal done on the deepest one to fix it.

 

[Firas]

thank you very much dear Barniv yes the Cavity already hurting me and I got a meeting to repair it, any way I dot a 3d Xray and it is in a CD I made Iso file and I will upload it and send you the link
thank you very much dear for your help I really appreciate it

 

[Firas]

the link of the ISO file of the CD is

http://ovh.to/T8q5Thc

and this is a short Video that I did to show you the position of the nerve
I think I'm ok what do you think ????

 

[Zuri Barniv]

The video is not helpful. Can you show me pictures where you see the tooth and the nerve in cross sections - like what you would see if you were looking through the jaw bone. That program you have should be able to do that. If you want, upload the files and I will run it on my program. The files should be in a DICOM format and there may be a few hundred of them in the folder.

 

[Firas]

Thank you for the answer dear,
I uploaded an iso file, I mean virtual cd image
If you have
Power iso, deomon tools or magic iso you can see the cd,
Or if you have CD burning software you can burn the iso file in a cd,
I prefer that you use the cd and see well because I'm not specialist in reading tomography, and in the cd there is many settings like adjusting image setting, display soft tissue, changing lighting,
Please, help me to know the real situation of my nerve because when I will go to a doctor I want to be ready and know every thing to be sure that he is doing every thing right
Now I'm using my phone when I will go back home I will try to check the DICOM files
But the cd that the doctor gave to me run automatically with luncher

 

[Firas]

I found DCM file in a folder called Images may be this file you need it
I shared some pictures that I think they are useful

and this is the link for the DCM file

http://ovh.to/Y7eqak9

do you thing that I will be OK ?
thank you really for every thing

 

[Firas]

I found an easy way to send to you my 3d Xray
1) download the file "tomography.zip" from this link -click here to download-
2) unzip the file
3) you will find a file called "Romexis_Viewer.exe" double click on it
4)

then you will find a window like that

select the english languge then click start viewer from the cd and finally you will be able to see the 3d x ray and control it like you want

 

[Zuri Barniv]

Mohamed, it is hard for me to see clearly without the DICOM files and I don't want to install anything on my computer. The bottom line is the 3D x-ray needs to be used and interpreted by the surgeon doing the work. The nerve is very close to the tooth. An unskilled and inexperienced surgeon will cause damage there even if they have a 3D x-ray. The best advice I can give you is to see a surgeon that is familiar with 3D x-rays, takes the risk here seriously and explains to you their experience in this matter. If you are satisfied with their response, I would go forward. Obviously, any surgeon who has this 3D x-ray has a big advantage because they know the best way to remove the tooth and minimize your risk.

 

[Firas]

thank you for the clear answer doctor sorry for the inconvenient, I think DICOM files are special for your software and I'm sure I have no DICOM file, but I looked for a tutorial how to use my software and I found this picture is it more useful ?

 

[Zuri Barniv]

Yes, these views are much more useful, but my original advice from my last post remains unchanged. You need to work with an experienced and skilled surgeon to minimize your risk and they need to use this 3D x-ray when planning your extraction.