Coastal Jaw Offices with Three Convenient Locations:

8845 Hawbuck St Trinity, FL 34655

727-375-0469

2711 Tampa Rd Palm Harbor, FL 34684

727-786-1631

4372 Commercial Way Spring Hill, FL 34606

352-596-6804

Drs. Michael A. Pikos |G. Thomas Peak III |José F. Lázaro |David M. Owsley | Michael S. Willis

The Countdown Begins..

Dr. Pikos founded Coastal Jaw Surgery in July 1983 and is the senior member of a five surgeon practice. He has ex-

tensive experience in implant surgery, having placed more than 15,000 implants and having performed thousands of

hard and soft tissue grafting procedures. He emphasized interactive CT technology along with foundational princi-

ples of prosthetics and biomechanics that dictate the ultimate success of comprehensive implant rehabilitation.

Since 1990, he devoted his practice exclusively to implant dentistry.

Kids Have the Darndest Things By Michael S. Willis, DMD In formulating a differential diagnosis when

pathology is encountered, age of the patient is

often considered. Many lesions tend to occur

within a special age group. Certain lesions are

often consistent with younger patients.

An 8 year old female of Middle Eastern origin

was referred to us to evaluate a radiolucency

posterior to #30. The patient’s medical history

was reviewed and found to be non-

contributory. She was not taking any medica-

tion and had no drug allergies.

A clinical and radiographic evaluation

(Panorex A) revealed a unilocular radiolucency

distal to #30 with #31 displaced horizontally

and posteriorly. No intraoral expansion was

noted and the area was not symptomatic. A

cone beam CT was taken to view the (CBCT

A) lesion in three dimensions and to assist in

formulating a differential diagnosis. The im-

pression of the CT was that of an odontogenic

neoplasm.

Panorex A

CBCT A

continued on back

Case of the Month: Kids Have the Darndest Things

continued from front

A differential diagnosis included:

1. Dentigerous cyst

2. Calcifying odontogenic cyst

3. Ameloblastic fibroma

4. Ameloblastic fibro-odontoma

5. Central giant cell tumor

A biopsy of the lesion was indicated. Our list demonstrated that each lesion is typically treated with an enucle-

ation and curettage. Therefore, an excisional biopsy was planned. An IV Sedation was performed to explore

and remove the lesion. An aspiration of the area was performed first to rule out a vascular lesion. A buccal flap

was reflected and the lesion was removed completely.

Submission of the specimen for microscopic examination revealed it to be an ameloblastic fibroma which was

on our differential list. An ameloblastic fibroma is a proliferation that occurs in children and teenagers. Very

few cases are seen beyond the age of 25. The mandibular molar area is the preferred site. There is no sex predi-

lection. Because of the age of occurrence, the mass often displaces developing teeth and can displace the infe-

rior alveolar canal. Enucleation and curettage is generally curative and has a low recurrence rate.

Our second patient was an 11 year old female referred for a

radiolucency discovered by a panorex in the mandibular left

body. (Panorex B)The patient’s medical history was unre-

markable, no medications were being taken and no allergies

were found.

A clinical and radiographic evaluation revealed a unilocular

radiolucency inferior to teeth 18 and 19. The area was asymptomatic and clinically did not demonstrate expan-

sion. A CBCT was taken to demonstrate the extension of the lesion and assist in developing a differential diag-

nosis. The CBCT revealed an oval, unilocular radiolucency that was indeed expansive in multiple directions

including displacing the mandibular canal. (CBCT B)

A differential list included:

1. Aneurysmal bone cyst

2. Central giant cell tumor

3. Central arteriovenous hemangioma

4. Ameloblastic fibro

5. Odontogenic keratocyst

Panorex B

CBCT B

CBCT B

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Implants can restore chewing function to the equivalent of someone with

natural teeth. If you have questions or want to know if your patient is a good

candidate for implant tooth replacement therapy, please call our office.

Continued

The first four are consistently found

in younger individuals. The first

three lesions are consistent with in-

creased vascularity. The literature

often debates the existence of an

aneurysmal bone cyst as it frequency

develops secondarily within other

lesions of prominent vascularity.

The central AV hematoma or AV

malformation as it is often referred is

the most serious and are life threat-

ening.

Secondary to the possibility of a vas-

cular lesion, this patient was referred

to the department of Oral and Maxil-

lofacial Surgery, University of Mi-

ami, for further evaluation and treat-

ment. Treatment required a hospital

with experienced staff and facilities

for diagnosis and ultimately treating

the patient in a safe environment. A

vascular lesion often requires Dop-

pler imaging and angiogram to diag-

nose and demonstrate the extent and

proliferation of the lesion. Selective

embolization, possible jaw resection

with immediate reconstruction is of-

ten required.

The TV host Art Linkletter wrote a

book, “Kids Say the Darndest

Things.”Some of those oldsters out

there will remember. Age related

lesions help formulate our differen-

tial diagnosis and sometimes-“Kids

Have the Darndest Things.”

WE WELCOME

YOUR FAMILY AND

FRIENDS TOO!

Referrals and word-of-mouth

recommendations are our number one

source of new patients. In fact, one of the

best compliments we can receive from our

colleagues is the referral of one of your

friends, patients or family

members. When you give us a good

reference, we will ensure that the person

you refer receives special attention and the

finest service possible.

Our extensive surgical training and

experience allows us to understand and

provide a wide range of smile solutions.

We believe in creating the smile our

patients are looking for using

progressive surgical techniques and

technology.

Thank you for your confidence in our

services, and for sending your friends,

family and patients our way!

In Coastal Jaw Surgery’s continuous efforts

to provide the best care possible, we have added

the Carestream 9300 3D cone beam CT scanner

system to all of our offices. This powerful device is a

real-time 3D imaging system that will revolutionize

our patient imaging and treatment capabilities.

This versatile 3D system meets a full range of

imaging needs. This system delivers clear 2D pano-

ramic radiographs, which form the foundation of

most cases. Since some cases call for additional

anatomic detail, the systems multiple real-time 3D

imaging capabilities support a wide range of clini-

cal applications with focused field images. This in-

cludes both single and dual jaw images, temporo-

mandibular joint images, sinus, and maxillofacial

views.

Once more, because our new 3D system al-

lows our technicians to target an exact area for im-

aging, our patients are exposed to significantly less

x-rays compared to traditional CT imaging. Also,

because this is a digital system, the amount of x-ray

is significantly reduced for any of the images we

need to obtain. The system combines speed, im-

age quality, and precision to dramatically reduce

the need for retakes. By using less x-rays than con-

ventional spiral CT scans, the Carestream 9300

cone beam system better helps us adhere to the

principle of “as low as reasonably achiev-

able” (ALARA), which we follow to ensure that we

take every precaution to minimize the patient’s ex-

posure to radiation when obtaining the necessary

diagnostic images needed for treatment planning.