Cavitation, Dentist Charlotte NC

The scientific term for a cavitation is an "osteonecrotic lesion". An osteonecrotic lesion is an area of dead tissue and infection in a bone. By far the most common bones in the body to have cavitations are the jaw bones.

One type of osteonecrotic lesion is a NICO lesion. NICO is short for Neuralgia Inducing Cavitational Osteonecrosis. NICO lesions cause pain in the jaw. 

Occasionally a patient will present to Dr. Plascyk's office in pain that cannot be related directly to a tooth. When all diagnostic and treatment alternatives are exhausted to eliminate the pain with traditional dental care, Dr. Plascyk may refer the patient out to a neurologist. If a pain relief is still not achieved then Dr. Plascyk may pursue diagnosis for a cavitation. 

                                              All the cavitations Dr. Plascyk has treated in his office have been
                                               pain inducing NICO lesions. These were treated after all other
                                               causes for the pain were properly excluded.

When treating a potential cavitation, Dr. Plascyk will send a patient to a radiologist and have a cone beam imaging CT scan completed. Cone beam imaging is a well documented and accepted contemporary technology. If the cone beam image CT scan shows an abnormal area of decreased bone density then Dr. Plascyk may initiate treatment. Treatment may include a biopsy only or exploratory surgery. During surgery if Dr. Plascyk determines an osteonecrotic lesion exists he will debride the area (remove the dead or infected tissue) and take a biopsy of the lesion. Next, he will clean out the area using traditional techniques and treat the area with oxygen/ozone as an additional antimicrobial therapy. Often times Dr. Plascyk will place bone grafting material in the surgical site after it has been cleaned to regenerate new healthy bone. The biopsy is sent to an oral pathologist to confirm the diagnosis of an osteonecrotic lesion. Eventually another cone beam image can be taken to see if the lesion has healed normally. A Cavitat is another instrument that can be used as an additional diagnostic aid. Personally, Dr. Plascyk does not use a Cavitat. Officially, the Cavitat is not approved for diagnosing cavitations but is approved as a diagnostic aid. However, some doctors with a lot of experience using a Cavitat feel strongly that it helps them diagnose cavitations.

Understand that cone beam imaging CT scan does not diagnose cavitation or osteonecrotic lesion. A CT scan can only determine that there is a radiolucency (area of low bone density) in the jaw. A diagnosis cannot be confirmed until a biopsy is taken and a pathology report confirms it was an osteonecrotic lesion.

Traditional dental x-rays (even digital x-rays) cannot diagnose cavitations either. Traditional dental x-rays (panoramic x-rays included) are not accurate enough to show most radiolucencies that may be osteonecrotic lesions.

The following is a cavitation case Dr. Plascyk treated in his Charlotte, North Carolina dental office:

Case info: 63 year old female. Suffering from chronic lower right jaw pain. No signs that pain was coming from teeth.

Traditional Panoramic x-ray showing no obvious pathology in lower right jaw bone

Digitized CT image shows radiolucencies (dark areas) in lower right and lower left.

Digitized section of ct scan of lower right.

Exploratory surgery lower right  area. There is a small hole in on the surface of the bone.

X-ray showing an implant drill placed in the hole. The implant drill dropped in the existing hole. No drilling was done. The bone was hollow in this area.

This picture reveals the extent of the cavitation in the bone. Only the roof of the cavitation was removed revealing a large hollow void in the bone. There was no hard or soft tissue in the lesion. The lesion extended down to the large mandibular canal containing nerves and blood vessels to the jaw and teeth. The walls had a leathery texture. The walls were cleaned with traditional dental techniques to expose healthy bone. The entire surgical site was treated with ozonated water and oxygen/ozone gas as an additional antimicronial therapy. Finally the site was grafted with bone grafting material to regenerate healthy bone in the site.

The x-ray show bone grafting material that was placed during the surgery. A pathology report revealed that the lesion was a NICO legion. The patient presently does not suffer from pain in the area.




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