Dr. Parashar reviews the value added of the PaX-i Insight from Vatech America as it related to Extraoral Bitewings and Panos.

2. Shortcomings of conventional bitewings
• Overlapped contacts
• Poor contrast
• Movement artifact
• Diagnosis of Incipient enamel carious lesions
Challenge with conventional bitewings

3. PaX – i Insight Bitewing Projection
Overlapped Contact Between #18 and #19Non-Overlapped # 18Non-Overlapped # 19
Overlapped contact between # 18 and #19
Advantage:
Layered Images of Insight Can
Unmask Overlapping

4. PaX – i Insight Bitewing Projection:
Healthy Asymptomatic Individual
Incipient Enamel Lesion
Advantage:
Improved Diagnosis of Interproximal caries

5. PaX – i Insight Bite wing Projection
Wear facets on occlusal surface from
bruxing/clenching
Advantage:
Sharp Image with Improved
Contrast Shows Minor Tooth
Changes

6. PaX – i Insight Bite wing Projection
Traditional Panoramic Positioning
Minimal to no-interproximal overlapping
Flat Plane Panoramic Positioning
Interproximal overlapping
Advantage:
Reduced Interproximal
Overlapping

7. Depth added 2D
PaX-i Insight

8. Insight1
Patient has high caries index evidenced by multiple fillings and crowns
Overlapped contact between teeth # 6 and #7. Similar issue of overlapped
contacts is common on Periapical and Bite Wing radiographs
Q. Caries on mesial of tooth # 6 Or, distal of tooth # 7?
Panoramic slice # 19 clearly shows non-overlapped Mesial surface of #6
Panoramic slice # 14 clearly shows non-overlapped Distal surface of #7
Thus, providing non-overlapped superior images possibly assisting
in superior interproximal caries identification and diagnosis

9. Insight1
Radiolucency distal to tooth # 30
Q. Is this radiolucency a cyst? Is this radiolucency communicating with distal root?
In addition, lets evaluate Mesial root
Slice # 23 shows lamina dura, suggesting that radiolucency
is not a cyst and not originating from tooth
Slice # 26 shows possible perforation/stripping of mesial root
and short fill on mesial root

10. Insight1
Evaluation of existing restorations on right maxillary posterior teeth
Slice # 26 shows marginal discrepancy on distal surface of
tooth # 3

11. Insight1
Right Sinus Floor vs. Left sinus floor
Left Floor is clear with no sign of pathology
Right Floor exhibits soft tissue density, labelled by red oval
Q. Is Right floor intact? Or, if pathology is destroying right maxillary sinus floor
Slice # 22 clearly shows normal root architecture and intact floor of
maxillary sinus.
Thus, requiring no further imaging or treatment of right maxillary sinus

12. Insight1
Endodontically treated tooth # 20
Q. Interpretation of apical end of tooth # 20
Slice # 23 clearly shows missing lamina dura in apical third
Suggestive of persistent/ resolving apical periodontitis

14. Superimposition observed on right TMJ
Slice # 10 clearly shows Right TMJ

15. Q. Tooth # 3 – PARL?
Slice # 18 shows widening of periodontal ligament space
around Non – Superimposed MB root

16. Anterior teeth are difficult to image on traditional panoramics
Q. Extent of root resorption on mandibular anterior teeth
Slice # 25 clearly shows extent of root resorption on anterior teeth

17. Q. Any significant finding associated with mandibular molars?
Slice # 22 shows radiolucency in Mesial cervical portion of tooth # 30
Normal Surface
Possible Caries/
Root Resorption

18. Thank You.