CANARAY Interesting cases

Unusual bone pattern in ramus
Possible fibrous dysplasia with simple bone cysts
Possible ameloblastic fibro-odontome
preventing eruption of tooth 21.
Sialoliths in right parotid duct
round laminated appearance
Odontogenic keratocyst in right posterior mandible
Calcification of the left eustachian tube
There is calcification noted within the left Torus tubarius, adjacent to the fossa of Rosenmuller. The appearance is suggestive of partial calcification of the cartilage of the left Eustachian (auditory) tube.
Midline defect in clivus
developmental anomaly
No recurrence of keratocyst
posterior right mandible (1.5 year follow up)
Hypercementosis at tooth 36 with unusual periapical inflammatory response.
The mesial root of tooth 36 exhibits hypercementosis, is partially fractured, and exhibits an adjacent granular, hydraulic periosteal bone response.
Buccal bifurcation (paradental) cyst involving tooth 48
There is a paradental cyst at tooth 48 displacing its roots
Possible chondrosarcoma in right anterior maxilla
Lytic bone loss combined with soft tissue calcifications
Healed central giant cell granuloma
serial imaging demonstrates bone infill
Follow-up scan on mandibular fibrous dysplasia - relatively stable
Overlay of scans exhibiting stable size of mandible with internal bone turnover
Silicone implant in buccal mandibular bone defect
Uncommonly seen
Butterfly vertebra associated with C3
Rare developmental anomaly
Metal view of implant 21
demonstrating fully seated abutment
Recurrent keratocyst asssement
Gorlin Goltz syndrome
Cemental tear
Cemental tear along the distolingual root surface of tooth 41, resulting in periodontal bone loss.
Odontogenic keratocyst (awaiting histopathologic confirmation)
Possible odontogenic keratocyst exhibiting expansion and root resorption.
Multilocular radiolucent defect in sphenoid bone
partially captured in a scan for dental implants
Metal view of implants 11 and 12
detects metallic density difference between implants
reduction in size of endodontic lesion
at tooth 27 in serial images
Fibrous dysplasia and simple bone cysts
posterior left mandible
Metal view of post
shows that it does not perforate root surface
Multilocular radiolucent lesion in posterior left mandible
Multilocular radiolucent entity in the posterior left mandible with a main large locule and a small round loclue. This entity has caused mild to moderate hydraulic expansion of the contiguous cortical borders and severe, smoothly-contoured external resorption of the involved teeth. The imaging findings are suggestive of aggressive benign odontogenic cystic or cystic tumor such as ameloblastoma. Pending histopathology results.
Multilocular radiolucent lesion in posterior right mandible
A moderately well-defined, non-corticated multilocular radiolucent entity in the posterior right mandible. Multiple internal thin straight and curved septations and prominent endosteal scalloping. No significant signs of bone expansion or teeth displacement. The differential interpretation includes odontogenic keratocyst and odontogenic myxoma. Pending histopathology results.
Possible vascular lesion in posterior right maxilla
radiographic images and trios surface scan acquired for this report
Cystic lesion in anterior maxilla: possible median alveolar cyst
Cystic entity in the buccal aspect of the anterior maxilla interproximal to teeth 11 and 21. The cystic lesion is continuous with the anterior aspect of the maxillary midline suture. The maxillary incisors are not affected. The imaging findings are suggestive of the presence of a developmental cystic lesion, and the most likely interpretation is median alveolar cyst.
Fusion and malformation of teeth 45 and 85
tooth has poor prognosis
Serial overlay for post-surgical assessment of lesion in right maxilla
no signs of recurrence
Overlaid scans of TMJs in mandibular open and closed positions
our new technique for reporting TMJ scans
Possible benign tumor in pericoronal region of tooth 18
preventing eruption of tooth
Possible hemangioma in left mandibular body
slight increase in size when compared to prior scan
Recurrent odontogenic keratocyst at tooth 27D
evident in overlaid scans
CBCT merged with Trios data for pathology case
fluctuant swelling on palatal surface caused by a calcified fragment embedded in gingiva
Trios scan merged with CBCT data for pathology case
soft tissue lesion in maxillary hard palate is not affecting the underlying bone.
Incidental finding on an implant planning scan
may be early keratocyst
Healed post-treatment appearance of dentigerous cyst at site 38
4 year follow-up for recurrence
Langerhans cell histocytosis (Confirmed recently via biopsy)
signed out radiographically as malignancy
Defect in anterior hard palate
etiology currently unknown
Trios and CBCT data for pathologic diagnosis
merged data for report
Possible central osteoma in posterior left mandible
if confirmed, this would be an extremely rare lesion
Early detection of lesion in implant case
in anterior mandible
Dilated odontome
at site 25
Large dentigerous cyst in posterior right maxilla at tooth 18
Completly occupies right maxillary sinus
Mandibular and skull abnormalities characteristic of Neurofibromatosis
The medial aspect of the right mandibular ramus exhibits bowing at the angle and the mandibular condylar head is significantly small and exhibits degenerative changes. The right sigmoid notch appears widened. There is also a corticated depression on the lateral aspect of the ramus inferior to the sigmoid notch.
Possible early ossifying fibroma
incidental finding on implant CBCT scan
Osteoma in lingual posterior left mandible
An exophytic, pedunculated growth of cortical bone is visible on the lingual surface of the posterior right mandibular body superior to the mandibular angle
Healing nasopalatine duct cyst
reparative bone pattern visible 6 months post-surgically
Sequestrum in anterior right mandible
osteomyelitis
Possible myositis ossificans in region of medial pterygoid
A spherical and laminated calcification is present medial to the anterior border of the left ramus,
Calcifying epithelial odontogenic tumor
Anterior mandible
Ameloblastoma
Right mandibular ramus
Possible benign bone-forming tumor
Right manidbular body
Progressively enlarging dentigerous cyst over 6 year period
at tooth 38
surface scan of palatal lesion overlaid with CBCT data
pathology case incorporating surface scan data
Dilated odontome
at site 32
Buccal access attempt for a lingual supernumerary tooth
CBCT definitively localizes the tooth position
Odontogenic cyst or neoplasm associated with impacted tooth 48
Odontogenic cyst or neoplasm associated with impacted tooth 48
Accessory canal of inferior alveolar nerve in anterior left ramus
no pathology in the region
Lytic bone pattern in posterior 2nd quadrant
incidental finding for an implant/endo case.
MRONJ in left mandible
sequestering bone at sites 35 to 38
Bone loss in anterior mandible that did not respond to endodontic treatment or antibiotics
biopsy recommended to rule out malignancy.
Unusual bone pattern in posterior left mandible
very vascular-seeming
Stafne bone defect
Defect appears large
Dens in dente on tooth 22
Interesting example of a dens in dente with periapical rarefying osteitis
Serial images of left maxillary tuberosity
history of keratocyst removal. assess for recurrence.
Benign tumor in 4th quadrant
referred for imaging to rule out endodontic issue
Nasopalatine duct cyst
Nasopalatine duct cyst
long history with this case
and progressive bone loss over several years
Possible dentigerous cyst
Cystic lesion located pericoronal to tooth 38
History of sinonasal surgery
absent inferior left nasal concha and medial wall of left maxillary sinus
Overlay of prior and current scan
showing peripheral healing bone pattern at site of marsupialized nasopalatine duct cyst.
Fibrous dysplasia in posterior right maxilla
classic features
Linear radiopacity in right inferior alveolar nerve canal
may represent retained contrast material
Persistent cyst in posterior right maxilla
post surgical appearance after attempted enucleation
Signed out as malignancy by Canaray but ...
with medical CT with contrast, it was revealed to be and arteriovenous malformation
possible early cystic lesion spotted in implant case
incidental finding
Referral for odontoma, but a little oral radiology magic shows the actual diagnosis
it's graft material
Osteoma in posterior right mandible
not captured in region of interest in prior scan 217381
Restorative materials extruded into IAN canal
Diffuse distribution of material in left mandibular body
Recurrent odontogenic keratocyst
definitively detected via serial overlay.
Serial imaging of lesion that was formerly healing now showing recurrence
at site 48
Nerve compression by uprighted tooth causing pain
by compressing the right inferior alveolar nerve canal.
Why can't the dentist achieve a satisfactory mandibular nerve block?
This CBCT provides an answer
Possible Klippel-feil syndrome
full skull scan
An example of the the good and bad things about serial overlays
fascinating case
Before/after bone graft
serial overlay of CBCT scans
Calcification in airway producing asymmetry
unknown etiology. Medical referral recommended.
Simple bone cyst in posterior left mandible
The maintenance of the lamina dura around the roots of teeth 35 and 36 supports this interpretation.
Radiopaque "lesion" in anterior left maxilla
is actually a prior bone graft related to a former apical lesion at tooth 22
Mandibular closed lock
No translation of condylar heads, as seen in this overlay of closed (grey) and open (red) scans.
Dysplastic bone in right mandibular body
possibly fibrous dysplasia - radiographic follow up recommended.
Expansile fibro-osseous lesion in left maxilla
Possible ossifying fibroma
Cystic lesion associated with tooth 48
Possible dentigerous cyst
Unusual pattern of bone loss at tooth 16P
possible malignancy
Possible cementoblastoma at tooth 36M
overlaid with prior scan. note obliteration of mesial root apex. revised diagnosis from PCD to cementoblastoma
serial overlay 2 years apart
demonstrates maturing bone dysplasia
Unusual appearance of hyoid bone
medical imaging recommended, because we don't know what this is
non-corticated bone destruction at site 25
without soft tissue mass. Possible myxoma
Comparison of prior and current scan
demonstrating effect of orthodontic movement of tooth 23 over 2 years
volumetric comparison demonstrating 3 different types of changes
anterior maxilla - recurrent keratocyst
Putative canal postions overlaid on tooth 27
to aid endodontic treatment planning
Large odontogenic lesion in posterior left mandible
possibly a keratocystic odontogentic tumor
BRONJ at site 38
following tooth extraction
Possible vascular lesion in C2
such as hemangioma
Ameloblastoma not treated after initial radiographic report in 2017
has increased in size in the 2 year interval between scans
Possible osteomyelitis apical to implant 45
may be related to implant osteotomy. biopsy indicated to rule out non-inflammatory process
Why do oral radiologists exist?
This is why
Possible Pindborg tumour
There is an expansive mixed radiolucent- radiopaque moderately-defined entity in the right mandible, which extends from the root of tooth 43 to the roots of tooh 48, and from the alvealar crest to the inferior border of the mandible, which is partially captured in this image volume. The buccal and lingual cortical plates as well as the inferior border of the mandible are significantly expanded, thinned
Neural tumor in left inferior alveolar nerve canal
Extremely rare case
Post-surgical follow up in 6 years
bone changes noted in overlays.
Benign aggressive tumor lingual to tooth 35
Does not originate at the tooth .
Size of scan makes a difference
Here is an example where an inaequately sized scan did not capture the lesion fully. The patient will be coming to Canaray for a scan of the entire right maxilla, to fully capture the extent of the lesion.
Possible ameloblastic fibro-odontime in posterior 2nd quadrant
preventing eruption of teeth 25, 26 and 27
Pericoronal cystic lesion at tooth 48
possible dentigerous cyst
Large osteolytic lesion in right maxilla
Extensive bone destruction present.
Benign lesion in posterior left mandibular body
possible simple bone cyst
possible odontogenic keratocyst
in posterior right mandible
Marsupialized cyst at site 26
Non-healing entity in serial images
Extensive osteomyelitis/MRONJ in mandible
There is severe sclerosis of the mandible and poorly-defined region of osteolytic area extending from the mandibular midline to the right and left mandibular molars along the lingual aspect of the alveolar bone. The lingual cortical plate is partially sequestrated along the this region
Osteoma at the inferior mandibular border
A well defined bony exostosis is present in the inferior/lingual aspect of the right mandible apical to site 43/44. This entity is composed of cortical bone and its partially continuous with the underlying inferior mandibular cortex. Based on the shape of the protruding/pedunculated bone, this most likely represents an osteoma, which should be monitored for growth over time. The patient should be assessed for the possible additional osteomas in the body and to rule out associated syndrome.
Large cystic lesion in left maxilla and maxillary sinus :possible secondarily infected
A large unilocular cystic lesion is present the left maxillary alveolar process and the left maxillary sinus. This entity has displaced and expanded the walls of the left maxillar sinus. The posteriorlateral and lateral walls of the left maxillary sinus are siginficantly, thinned, expanded, and are partiially lost, which suggests that the cystic lesion may be draining into the buccal space at this region.
Serial overlays demonstrate complex growth situation of lesion
in posterior mandible
Tiny odontome-like structure displacing tooth 47 distally
in panoramic image
Sequestered lingual mandibular torus
Osteomyelitis in right mandibular body
Radicular cyst
in anterior left mandible
Large cystic lesion in left maxilla
occupies sinus space
Early recurrence of keratocyst
in posterior maxilla
No signs of recurrence of lesion in serial imaging
bone in posterior right maxillary tuberosity has a stable appearance.
Serial imaging demonstrates stable post-treatment appearance
no recurrence of lesion
This case has a pan and a CBCT
The CBCT shows that no mucositis is present in the sinuses, but the pan appears to demonstrate mucositis. The lesson is: don't trust 2D images for definitive soft tissue findings.
Serial overlays of scans demonstrating bone graft
The newly grafted material is shown as grey-colored bone
Pseudoarthrosis in left mandible
partially captured in scan.
zygomatic implants
bilaterally
Very small changes in lesion size demonstrate the value of serial overlays
in order to determine whether an endodontic treatment was successful or not
Possible familial adenomatous polyposis
Multiple dense bone islands in mandible + osteomas: rule out familial adenomatous polyposis
Periapical cemental dysplasia and fibrous dysplasia
in anterior mandible
Chewing gum present
positioned between tongue and left hard palate
Interesting pattern of external resorption
on tooth 11
reduction in size of the lesion in pericoronal region of tooth 48
in successive scans, spaced 5 years apart
Recurrent ameloblastoma
right mandible
Possible chondrosarcoma
left coronoid process
Post-traumatic partially healed manidbular alveolar process
Linear radiolucency apical to anterior mandibular teeth.
Possible osteosarcoma in right TMJ
bone forming tumor with spiculated appearance
synovial chondromatosis
In the right TMJ
Ameloblastic fibro-odontoma in left posterior maxilla
Mixed radiopaque-radiolucent lesion in 18 year old patient causing displacement of impacted tooth 28
Iatrogenic fracture and subsequent osteomyelitis
in posterior 4th quadrant
Bone dysplasia apical to tooth 46
Larger than a typical periapical cemental dysplasia, and could represent fibrous dysplasia
Serial overlay of scans before and after grafting
simultaneously showing areas of new graft and areas of ridge atrophy
Aplasia of posterior arch of the atlas (C1)
Incidental finding of developmental anomaly on lateral ceph
Recurrent odontogenic keratocyst
Multiple sites of recurrence
CBCT scan explains apparent "horizontal fracture plane" on periapical radiograph
it actually is the superimposition of an open margin on the palatal surface of the palatal root.
3x scans overlaid
demonstrating TMJs in multiple positions
No change in size of maxillary incisive canal in scan interval
may represent anatomic variant rather than pathologic finding
This is a situation where a malformed tooth is positioned mesiobuccally to tooth 22, and a canine is missing.
The referral labeled this as a supernumerary tooth, and it was reported that way for consistency. However, whenever you have a supernumerary tooth in close proximity to a missing tooth site, it is probably better diagnostically to have one diagnosis instead: ectopically positioned tooth (an ectopic tooth 23, in this case). Anyway, this tooth was unfortunately extracted, due to it being labeled as a supernumerary tooth.
Gemination
of tooth 21
Healing marsupialized Odontogenic Keratocyst
1 year follow up with serial imaging
Fibrous dysplasia in right mandible, simple bone cyst in left mandible
Referral for recurrent multilocular radiolucency in left mandible, history of prior surgery by another clinician
cystic lesion with internal radiopacities
appearance suggestive of a calcifying cystic odontogenic tumor or longstanding residual cyst with dystrophic calcifications
facial trauma
post-fixation appearance
Osteoma in right ramus
A relatively large osteoma is present along the posteromedaial aspect of the right ramus posterior to the mandibular foramen. The radiographic features that support this diagnosis are the internal structure composed of granular cortical bone, with a pedunculated appearance, which appears to originate from the medial cortex of the ramus and extends to the medial pterygoid muscle area.
possible phleboliths in left sublingual region
may be suggestive of the presence of a hemangioma in this region.
Very interesting presentation of dystrophic calcifications in a longstanding radicular cyst
concentrically positioned calcifications within the cyst giving the impression of a cyst within a cyst.
Large unilocular cystic lesion in posterior 1st quadrant
appears to be a longstanding lesion
Odontome (most likely compound) developing palatal to tooth 13
note faint hints of enamel and small toothlike structures
Ectopic bone formation mimicking odontomes
in 2nd quadrant (referral query was for supernumerary teeth)
No recurrence of keratocyst in marsupialized post-treatment scan
in posterior left mandible . This case is interesting because we overlaid it 2 ways (greenscale current vs greyscale prior // greyscale current vs redscale prior). It turned out better with greyscale current / redscale prior
Histopatholocially confirmed Adenomatoid Odontogenic Tumor
At tooth 43
Pansinusitis
Severe sphenoid and ethmoid sinusitis requiring ENT intervention. Tooth 18 ruled out as major causative factor
Curved neurovascular channel mesiopalatal to tooth 11
CBCT scan clarified what appeared as a radiolucency associated with tooth 11 on a periapical radiographc.
No signs of recurrence of ameloblastoma
Serial overlays of scans demonstrate static appearance of post-surgical defect.
Multilocular lesion in right greater wing of Sphenoid bone
may be a vascular entity such as a central hemangioma or a prominent arachnoid granulation. Medical imaging of skull base recommended
Partially formed dense bone island
density of developing dense bone island is lower than that of the adjacent cortical bone
Fixation screw impinges upon right inferior alveolar nerve canal
producing symptoms of pain and numbness
Malignancy in right maxillary sinus
Sinus soft tissue mass, lytic bone loss, failed healing of extraction sockets
Osteoma at right gonial angle
Early stage lesion - incidental finding on panoramic image
Calcified facial artery
Non-significant, but this is a very clear scan of the soft tissue
Large nasoplalatine duct cyst
most likely a longstanding lesion
Cystic lesion associated with tooth 38
Possible dentigerous cyst or odontogenic keratocyst
Post-surgical defect
healed post-ameloblastoma reconstructed appearance
Florid osseous dysplasia
affecting entire mandibular arch
Progressive enlargment of osteoma between scans
prior scan (greenscale) overlaid on current scan (redscale). The red halo at the medial aspect of the entity represents the amount of size increase in the interval between scans
healing bone pattern after removal of sequestrum at site 42
Serial overlays of prior and current scans
Large cystic lesion at tooth 48
possible dentigerous cyst
Malformed tooth 34
Hopeless prognosis
Implant 46 extends through IAN canal
completely severed nerve
serial overlays demonstrate various states of post-treatment teeth
some healing (24, 25) , some no change (26), some worsening (27)
Tooth in left middle meatus of nasal cavity
may have been displaced into this position through sinus osteum or may have developed here.
soft tissue implant anterior to anterior nasal spine
spiral profile in coronal cross section
Dysplastic bone or healing simple bone cyst in posterior left mandible
partially captured in scan
Serial overlays demonstrate healing post-treatment appearance in posterior maxilla
several years after removal of cyst
Unusual osteophytes on condylar heads
osteophytes are on superior surfaces of condylar heads
Benign cyst or tumor in anterior mandible
causing resorption of anterior teeth
Example of ambiguous report
Tooth 41 was diagnosed with 2 conflicting findings. We should refrain from this, and stick to our mantra of 1 tooth, 1 finding, 1 diagnosis.
post-surgical appearance of left maxilla
no recurrence of keratocyst
Recurrent odontogenic keratocyst in posterior 4th quadrant
Continuous with the post-surgical defect at site 48
Fibrous dysplasia in the posterior left mandible
Heterogeneous bone pattern
Exostosis on anterior surface of body of hyoid bone
possible early osteoma
post-trauma maxillofacial scan investigating reason for limited opening
most likely limited range of right masseter, as suggested by prominent right antegonial notch
Infected cemental dysplasia at site 47
resulting in osteomyelitis
Retained mature focus of cemental dysplasia at site 16
implant placement contraindicated at this site
serial imaging of tooth 48 before/after the placement of a drain
no significant changes in the 5 month inteval between scans.
Large antrolith causing chronic maxillary sinusitis
Obstructed antral drainage
Voxel overlay of post-surgical appearance of cystic lesion in anterior maxilla
demonstrating bone formation at the periphery, which is indicative of healing. No recurrence
Collapsed radicular cyst in right maxilla
and recurrent periapical lesion at tooth 13 draining into sinus
Voxel overlay of periapical cemental dysplasia in anterior maxilla
demonstrating a very slight increase in size in 1 year interval between scans
Marsupialized radicular cyst
apical to tooth 26
Recurrent ododontogenic keratocyst
left mandible
inferior alveolar nerves encircled by roots of teeth 38 and 48
increased risk of iatrogenic damage
Serial imaging of socket 37 in Voxel
demonstrating formation of healing bone pattern between scans
serial overlay of lesion in anterior mandible
demonstrating growth over a 5 month interval
Large unilocular lesion in posterior left ramus
benign tumor or cyst
excellent example of serial overlay
in Voxel: perfect pre- and post-surgical appearance
Osteomyelitis
posterior 3rd quadrant
Unusual post-surgical healing bone pattern
Mimicking a retained root fragment. Serial imaging confirms that no root fragment was present
Possible unusual presentation of simple bone cyst
in posteror 4th quadrant
Dilated odontome surrounded by dentigerous cyst
at site 38
Marsupialized mucocele
In left maxillary sinus
Osteomyelitis indudced by endodontic lesion
at tooth 36
Choristoma buccal to teeth 24, 25 and 26
containing a marsupialized cyst
Large bone defect in anterior right maxilla
apical to implant 12. Most likely represents a marsupialized post-surgical appearance.
Radiolucency in middle cranial fossa
medical referral indicated
Odoontogenic cystic lesion associated with impacted supernumerary tooth
in anterior right maxilla
Bone graft extends into left inferior alveolar nerve canal
causing paresthesia
Healing bone pattern in successive scans
Healing bone shown with green overlay
benign odontogenic cyst at site 35
causing periosteal bone formation
Benign odontogenic lesion
mid 4th quadrant
Benign tumor in anterior 2nd quadrant
with calcified heterogeneous internal appearance
Florid osseous dysplasia
and simple bone cysts
Mesial root dilaceration of tooth 38 more prominent clinically than what was evident on cone beam CT scan
Periodontist provided clinical specimen of extracted tooth 38 with unexpectedly prominent dilaceration of mesial root
Large Dentigerous cyst
posterior right maxilla
Large unilocular cystic lesion in anterior second quadrant
Benign odontogenic cyst or cystic tumor
Serial overlays of a marsupialized cystic lesion in the anterior maxilla
demonstrating bone formation at the periphery, which is indicative of healing
Serial CBCT overlays demonstrate healing of post-surgical defect
in posterior left mandible
serial CBCT demonstrates persistent endodontic lesion
lesion at palatal root has increased in size since prior scan
Fibrous dysplasia of skull base
Possible future cranial nerve compression
osteotomy of mandibular sypmphysis affecting adjacent teeth
possible iatrogenic endodontic issues
Fibrooosseous ankylosis in right TMJ
Likely traumatic in origin, with ossification of an intraarticular hematoma
Non-integrated bone graft in right maxillary sinus
displaced within a region of sinusitis
Large odontogenic keratocyst
posterior left mandible
small change in lesion size in serial CBCT
between May and November 2017
Osteomyelitis
right posterior mandible
Concrescence of retained root fragment of tooth 28
fragment surrounded by rarefying osteitis
odontogenic keratocysts present at sites 28 and 38
rule out nevoid basal cell carcinoma syndrome
Malignancy in right maxillary sinus
possibly a squamous cell carcinoma
Very subtle potential recurrence noted in left maxilla
when compared to prior scan 1 year ago
Fusion of mandibular incisors
31/32 fused. 41/42 fused.
unusual pattern of external resorption and caries at tooth 27
crescent-shaped resorptive defect in mesiobuccal root.
Residual cyst at site 36
associated with retained root
Serial CT of post-treatment healing of excised ossifying fibroma
reduction in size of post-surgical mandibular body noted in 9 month interval
reduction in size of large cystic lesion in 9 month interval
serial CT overlays
No change in serial scans in 13 month interval
no recurrence of OKC
Serial overlays of post-surgical defect for exised OKC in 16 month interval
demonstrating no significant change
possible cementoblastoma
at tooth 36M
Metal artifact reduction
Producing strange appearance within the crown of implant 36
Possible surgical ciliated cyst
left maxilla
Serial overlays of scans
showing subtle increases in lesion sizes between March 2017 and November 2017
Stunted root development of maxillary teeth
The developing maxillary teeth exhibit stunted root formation
Particulate appearance of bone at alveolar crest in both arches
Possible history of unusual bone grafting or systemic condition inducing sequestration
Fibrous dysplasia in left mandible
Classic ground glass appearance
possible central giant cell granuloma
right mandibular ramus
oronasal defect in left hard palate
etiology unknown
Dentigerous cyst at tooth 28
causing impaction of the tooth
Subclinical fibrous dysplasia or vascular malformation
in posterior left mandible
Osteomyelitis
posterior 4th quadrant
Unusually oriented impacted teeth
in anterior mandible
Dilated odontome
at site 18
Multiple malformed teeth
in anterior maxilla. All with hopeless prognosis, due to short roots
Expansile lesion in gingiva of left hard palate
lesion orinates at site 24 or minor salivary gland
Central giant cell granuloma
Left mandible
Possible lesion of non-endodontic origin
apical to tooth 14
Benign lesion preventing eruption of tooth 38
Possible ameloblastic fibroma. Excisional biopsy recommended.
Ectopic enamel formation in developing tooth 28
would possibly form enamel pearls eventually.
Serial imaging of defect in anterior maxilla
No change in shape or size suggests that a recurrence is not present.
Ameloblastoma distobuccal to tooth 32
Small multilocular lesion mesial to healing socket 33. Family history of ameloblastoma
osteomyelitis in right mandible
multiple sequestra visible
Infiltrative malignancy in right posterior mandible
Cortical defects, lytic bone loss, lamellar periosteal bone formation - findings suggestive of extranodal lymphoma
This is why implant scans need reports
Benign bone forming tumor (possible central hemangioma) in left maxilla apical to tooth 24
possible malignancy in posterior 3rd quadrant
cause of numbness in region
Furcal rarefying osteitis arising from lateral canal
Tooth 36 demonstrating isolated furcal bone loss and a clearly visible lateral canal within the furcation
fibrous dysplasia
anteiror left maxilla
Cherubism
multiple giant cell granulomas
Surgically marsupialized cystic lesion
drainage tube visible in CBCT
Fibrous dysplasia with simple bone cyst
right mandible
Exostosis induced by bridge pontic
at site 46
Large odontogenic keratocyst
left mandible
Detection of microgap/microleakage between implant and abutment
at site 12. Normal implant 22 also shown for reference.
Implant 22 displaced into nasal cavity
Nonintegrated
Condylysis Tertius
Malformation of occpital bone in articular region of C1
Simple bone cyst in posterior left mandible
associated with mandibular molars
Central giant cell granuloma
left mandible
central giant cell granuloma
anterior left ramus
gemination of tooth 22
may not be possible to separate these two teeth
Possible sinus mucocele
In left maxillary sinus.
Juvenile ossifying fibroma
Classic radiographic appearance -- aggressive growth about a fixed epicenter, displacement of teeth, well-demarcated mixed radiolucent/radiopaque lesion.
Biopsy proven follicular ameloblastoma
Well-defined, corticated, somewhat multi-locular radiolucency in anterior left mandible, with reported soft tissue expansion
Residual cyst at site 16
Marsupialized upon removal of tooth 16
Subclinical fibrous dysplasia at anterior border of right maxilla
partially captured in scan (incidental finding)
How to decide which of two similar-appearing teeth to extract
Evaluate both teeth in 3D and choose the better of the two to keep.
Cystic lesion apical to tooth 35
Contains dystrophic or intrinsic calcifications
Infiltrative malignancy in right posterior mandible
Probable lymphoma
Dentigerous cyst in posterior left maxilla
associated with impacted tooth
Metastatic breast cancer
Source of numbness in left chin
Large unilocular cyst in posterior left maxilla
Occupying entire maxillary sinus
Mixed radiolucent/radiopaque lesion in right posterior maxilla
Possible calcifying epithelial odontogenic tumor (CEOT)
Ankylosis of tooth 12
at distal surface of coronal third of root, preventing orthodontic movement
Phleboliths in left buccal space
Multiple phleboliths within left buccal space
supernumerary tooth fused to tooth 46
shared root canal system
Possible surgical ciliated cyst
in posterior left maxilla
Subclinical fibrous dysplasia
Anterior left maxilla
Opacified loculation of right maxillary sinus
not a cystic lesion
foreign body in right maxillary sinus
near sinus osteum
Large osteochondroma in left condylar head
Encroaches left foramen rotundum
Small accessory palatal root of tooth 11
not visible on 2D image
Unusual appearance in right sphenoid bone
may be a vascular malformation
Possible minor salivary gland tumor in right hard palate
Could also be a draining endodontic lesion from fractured tooth 14
pathologic fracture of right mandible
secondary to osteomyelitis
lymphoma in the 4th quadrant
lytic bone destruction in region
Possible malignancy originating at nasal floor
Partially captured region of interest in scan submitted to Canaray for report
possible ameloblastic fibroma in posterior 2nd quadrant
unerupted teeth 26, 27, 28
Simple bone cyst in posterior third quadrant
Causing mild buccolingual expansion of the alveolar process
Uncommon position of traction wire
at inferior left orbital border
Tooth 28 displaced into right maxillary sinus
Oro-antral communication present
Osteomeyelitis in posterior 3rd quadrant
and iatrogenic damage to tooth 38
Forid osseous dysplasia with simple bone cyst
in left anterior mandible
Central giant cell granuloma
Benign bone-forming lesion in left maxilla
Recurrent odontogenic keratocyst in anterior second quadrant
drains through interradicular region of teeth 23 and 24
Pituitary microadenoma found on MRI
No findings on CBCT
Possible ameloblastoma in anterior right mandible
Expansile, multi-locular radiolucent entity causing root resorption
Chronic osteomyelitis associated with impacted tooth 37
Diffuse chronic inflammation associated with partially resorbed impacted tooth 37
Recurrent odontogenic keratocyst
posterior left mandibular body
History of surgery in thyroid region
Multiple surgical clips are visible at the level of the laryngopharynx
Chronic osteomyelitis associated with impacted tooth 48
Diffuse chronic inflammation associated with extensively resorbed impacted tooth 48
Possible marsupialized nasopalatine duct cyst
or history of large endodontic lesion at tooth 11 or 12
Hypercementosis and rarfefying osteitis at tooth 28
and rarefying osteitis at tooth 27
Simple bone cyst in right posterior mandible and ramus
Large simple bone cyst involving entire right ramus, preservation of follicle around developing tooth 48
Possible osseous dysplasia and simple bone cyst in anterior maxillla
history of Ewing's Sarcoma in left zygoma
Deformity in C1
Type D malformation according to the Currarino classification.
Possible crack in abutment 11
compared to abutment 12
odontogenic cyst or tumor in posterior right mandible
at site 48
Periapical cemental dysplasia and simple bone cyst at tooth 33. Periapical cemental dysplasia in pericoronal region of impacted 43
Also, supernumerary tooth between teeth 42 and 44
Possible osteoradionecrosis at tooth 36
history of radiation to left tongue
Nonhealing extraction sockets in posterior 3rd quadrant
history of radiation due to cancer in left tongue
Fixation screws extend into right inferior alveolar nerve canal
source of pain in 4th quadrant
Benign odontogenic cystic lesio between teeth 22 and 23
possibly a calcifying cystic odontogenic tumor
MRONJ in posterior mandible
Medication related osteonecrosis of the jaws
dens invaginatus at tooth 22
prominent example
Large unilocular cystic lesion in the left mandibular ramus
Possibly a simple bone cyst
orantral defect
at site 26
Clinically verified non-displaced vertical root fracture
Periradicular bone loss suggestive of root fracture on cone beam CT correlates with clinically visible fracture plane on extracted tooth
Hyperplasia of coronoid processes resulting in limited mandibular opening
Rare anatomic variant resulting in mechanical obstruction to condylar translation
Significant patient motion artifacts
An example of a scan that is non-diagnostic
Possible ameloblastic fibro-odontome
Preventing eruption of tooth 27
Ameloblastoma in posterior left maxilla
Looks aggressive
Persistent rarefying osteitis after endodontic treatment
may be related to the presence of secondarily affected hypercementosis
Lateral canal at tooth 33D
Visible lateral canal is source of vertical bone loss - good example of CBCT for endodontic diagnosis
Large simple bone cyst in left mandibular ramus
Simple bone cyst within left mandibular ramus, developing tooth 38 unaffected
Serial overlay demonstrating change in lesion size over time
pre-endo lesion shown in red. Post-endo lesion shown in green
Large odontogenic keratocyst
right mandibular ramus
Periapical cemental dysplasia with simple bone cysts
in anterior mandible
Accessory lingual root on tooth 47
Excellent example of CBCT diagnosis of endodontic pathology
ceph overlays
demonstrating subtle changes
Cystic lesion in posterior 3rd quadrant
possible multilocular component on lingual surface
osteomeylitis in posterior right mandible
prominent region of bone loss in surrounding region
Fibrous dysplasia in left maxilla
and sphenoid bone - narrowing pterygopalatine fossa
Possible buccal Stafne defect
If so, this represents an extremely rare variant with only a few case reports describing it
Osteomyelitis associated with resorbing impacted tooth
Diffuse sclerosis, periosteal bone formation, and draining sinus tracts within left anterior mandible due to rarefying osteitis arising from an extensively resorbed and impacted tooth
Complex odontoma
site 27
Florid osseous dysplasia
Extensive involvement of anterior mandible
Bilateral expansile osseous dysplasias in posterior maxillae
Smaller foci of dysplastic bone also noted in the mandible. Rarely, periapical osseous dysplasia can cause displacement of resorption of teeth. In the maxillae, the displacement can appear quite profound. However, the multifocal presence of multiple regions of dysplastic bone favor an interpretation florid osseous dysplasia over that of an ossifying fibroma.
Lytic bone loss in right posterior mandible suggestive of malignancy
Known history of breast cancer
Possible lymphoma
History of lymphoma + V3 paresthesia + lymphadenopathy -- see irregular widening of the periodontal ligament spaces, low bone density, small cortical dehiscences
Airway assymetry
Phyrangeal mass??
Defect in odontoid process of C2
of cervical vertebrae
IAN
going thru the root of 48
dentigerous Cyst
Unusual tooth anatomy: accessory root budding off a tooth 11
Persistent endodontic pathology of unknown source. CBCT imaging reveals accessory root budding off distal root surface of tooth 11.
Benign bone forming tumor
in right masticator space
cystic lesion in hard palatal gingiva
possible salivary gland lesion
Large odontogenic keratocyst
Posterior left mandible
fracture of Stafne defect
Medical CT - signed out as OKC by medical radiologist. We don't actually know what the real diagnosis is yet.
osteopenia
at 46
Gemination of teeth 18 and 28
multiple crowns emerging from a single root. Morphologic variants
Periapical cemental dysplasia
radiolucencies , mand anterior, post mand also.
Significant internal carotid arteries calcification
Gas bubbles in buccal soft tissue: medical or oral surgery referral indicated
possible facscial space infection
28 in Infratemporal fossa
Post extraction
Central Giant Cell Lesion in the anterior mandible
Implant displaced into left maxillary sinus
producing an oro-antral communication
Periosteal bone formation buccal to 46M
secondary to root fracture
genioplasty fixation.
Fixation apparatus , healed
implants placed through right inferior alveolar nerve canal
cause of paresthesia
Osteosarcoma in right maxilla
Lesion causing bone destruction and disorganized bone formation with associated soft tissue swelling
Unusual appearance of posterior right zygomatic arch
May represent pneumatization or a multilocular lesion. CBCT recommended
Oropharyngeal airway asymmetry
medical referral recommended
MRONJ
Obvious sequestrum development in posterior right mandible
Fibrous dysplasia in right maxilla
Classic features of fibrous dysplasia: uniform enlargement of right maxilla, granular bone pattern, hypoplastic right maxillary sinus
Ameloblastic fibro-odontome
causing impaction of tooth 55
Surgical bur in right maxillary sinus
prior to retrieval
Accessory mesial root in a maxillary lateral incisor
Another interesting anatomic variant--an accessory root has formed along the mesiopalatal surface of the coronal third of the root of tooth 22.
Multiple keratocysts
Possible Gorlin Goltz Syndrome
Ossifying fibroma in posterior left maxilla
Mixed radiolucent/radiopaque lesion with space occupying characteristics.
Osteoma in right coronoid notch
affecting range of motion
O-shaped tooth 16
Occasionally, we encounter C-shaped root canal systems, which can be challenging to obturate. Rarely, we will encounter an O-shaped root canal system. This is an extreme anatomic variant that is exceedingly rare.
Perforation and retained file fragment in 46M
This case shows the value of CBCT for endodontic diagnosis and treatment planning
BRONJ CASE
Bony sequestra
History of genioglossus advancement surgery
Healing post-treatment appearance
Focal osteoporotic bone marrow defect
in posterior 4th quadrant
Sublcinical fibrous dysplasia
in inferior left mandibular body
Right submandibular sialolith
laminated calcified appearance
Good example of clinically relevant incidental finding
Referred for tooth 11. External resorption on tooth 23.
Cyst or unilocular tumor in left mandibular ramus
Marsupialization appears to have occurred.
Ameloblastoma in anterior mandible
multilocular benign lesion in anterior mandible
Implant 47 impinges upon right inferior alveolar nerve canal
lip and chin numbness for past 10 years, as a result
Fixation screw impinges upon 26MB
Possible source of persistent periapical lesion in this region
Ectopic bone formation in right maxillary sinus
No effects on the surrounding structures
Large dentigerous cyst in posterior 2nd quadrant
which has displaced tooth 28 superiorly and medially
Macroglossia
has splayed the anterior teeth.
Serial CT overlay of bilobed lesion at tooth 36M
demonstrating decrease in size of anterior locule and incurease in size of the posterior locule
Large benign cystic lesion in posterior mandible
extends through ramus and posterior mandibular body
Large residual cyst in left maxilla
causing expansion of sinus walls
Vertical fracture in tooth 13
With endodontic sealer extending into fracture plane - pathognomonic sign of fracture
Extruded gutta percha into labial soft tissue
through root perforations of teeth 11 and 12
Soft tissue mass in right uvula
incidental finding on implant scan
Nasal polyp
in an implant case
Severe degenerative joint disease + limited translation in the left TMJ
Normal right TMJ
External resorption and inostosis
at tooth 21
Dens invaginatus of mandibular molar
producing rarefying osteitis
Arteriosclerosis or atherosclerosis of right facial artery
clearly visualized in this scan
CAD/CAM lateral window sinus lift guide
based on CBCT scan and intraoral surface scan
Prominent vascular channels at site 11
Mapped in CBCT scan. The risk of excessive bleeding during an implant osteotomy is increased to the hypervascularity of this region .
Developmental groove on palatal surface of maxillary incisor
Another good example of usefulness of CBCT for endo
Unfilled lingual canal in tooth 44
Great example of CBCT for endo
Secondarily infected fibrous dysplasia in anterior mandible
Possible risk of bone sequestration
Overlaid CBCT scans to determine if lesion changed in size over past year
Periapical rarefying osteitis at site 13 is the only change
Large marsupializing dentigerous cyst at tooth 18
Classic appearance
Antrochoanal polyp
Patient presented with left-sided nasal obstruction
Multiple midface fractures following MVA
Fractures involving left maxillary sinus walls, orbital floor, and zygomaticofrontal suture
Gemination of malfomed tooth 38
Causing severe bone loss around tooth 37
Phleboliths in right facial artery
At right mandibular antegonial notch
Ectopic bone formation in dorsum of nose
Appears to be a developmental or syndromic anomaly
Apical delta in tooth 26P
Visible on CBCT
Geminating supernumerary tooth 11A
two crowns, one root
Dense bone island or localized fibrous dysplasia in posterior left maxilla
The unerupted tooth 28 has been superiorly and posteriorly displaced
Nice radiographic guide
single tooth example
Paracondylar process
Developmental anomaly resulting in fusion between mastoid process and transverse process of C1
Condylus tertius
A developmental anomaly at the anterior border of foramen magnum
Scanning artifact mimicking crown fracture
in tooth 41. This artifact appears to be unique to the Carestream 9000 CBCT
Enlarged infraorbital canal
Dehiscence in floor of orbit. Rule out neoplasm
Fibrous dysplasia in left anterior maxilla
Localized focus of fibrous dysplasia in left anterior maxilla causing mild palatal expansion
Hyperpneumatization of the paranasal sinuses
Paranasal sinuses demonstrate extensive pneumatization. The maxillary alveolar processes appear expanded, which can be a rare sequela of pneumatization.
Inferior median clival canal / canalis basilaris medianus + Marsupialized Tornwaldt's cyst
The inferior median clival canal also known as the canalis basilaris medianus is a rare anatomical variant of the clivus, which passes in the sagittal plane from the intracranial surface of the clivus to its retropharyngeal surface. It is generally thought to represent a remnant of the notocord. This patient also exhibits a marsupialized Tornwaldt's cyst
Asymmetric inferior alveolar nerves
Very different passage of left vs. right nerve through mandibular body. Just because it looks a certain way on one side, don't assume that the other side will look that way
Visible curve fracture plane in tooth 47
Outlined with a red overlay in these images to demonstrate apical extension into mesial root
Implant 25 displaced into maxillary sinus
Oroantral communication present
Unusual post-surgical defect in anterior mandible
with bone graft partially covering the buccal surface
Pagetoid appearance of calvarium
Thickened and sclerotic skull bones
Large dentigerous cyst in left maxilla
almost complete displacement of sinus floor. "Double wall" radiographic finding support the diagnosis
Benign odontogenic tumor between teeth 32 and 33
Possibly an ameloblastoma, based on the multilocular appearance
fused C1 and C2
no anterior arch of atlas present
Posible simple bone cyst of the condylar head
A unilocular radiolucent entity with a thinly corticated periphery and scalloping borders is present along the medial pole of the left condylar head. This entity has thinned and slightly expanded the cortices of the condyle, but these cortices appear intact.
Hair ties showing up as coiled objects on pan and ceph
This is why all hair should be moved off the face and shoulders during image acquisition
Signed out by Canaray as sinus mucocele - turned out to be an odontogenic keratocyst
Biopsy confirmed that is was actually an odontogenic keratocyst
Possible segmental odontomaxillary dysplasia
Unilateral enlargement of the alveolar process, dense trabecular bone, vertically oriented trabeculi, lack of pneumatization
Large right submandibular sialolith
Demonstrating a concentric pattern of calcification
Lytic bone loss in right TMJ
Rule out malignancy
Dilated odontome at site 38
Malformed enamel and dentin clearly visible
Irregularly widened periodontal ligament spaces of all visible teeth
rule out infiltrative malignancy
Hypophosphatemia
This is rarely observed. Characteristic changes to teeth (enlarged pulp spaces, thin enamel lining) and bone (osteopenic, thinned cortices, etc.).
Possible ossifying fibroma in anterior 4th quadrant
Prior biopsy did not show any malignant features
Healed simple bone cyst with history of tooth displacement
This simple bone cyst caused some tooth displacement, which is an unusual finding associated with this diagnosis
Ameloblastic fibro-odontoma associated with tooth 85 + paradoxical relationship between teeth 85/45
Ameloblastic fibro-odontoma causing vertically impacted of tooth 85. Tooth 45 developing coronal to the vertically impacted tooth 85.
Accessory neurovascular bundle at tooth 48
completely enveloped by roots
Bisphosphonate-induced osteonecrosis
Lingual to tooth 47
Displaced vertical root fracture: good teaching case
Displaced vertical root fractures are rarely seen, but when they are present, some signs help differentiate this from beam hardening artifacts. 1) Radiolucent plane does not extend beyond root surface 2) Radiolucent plane is irregularly shaped (more zig-zaggy pattern than a straight line) 3) Step defects along the external root surface 4) Presence of periradicular bone loss adjacent to radiolucent plane
This wisdom tooth does not want to be extracted
Extreme morphologic variant with five distinct roots, two of which completely envelop the mandibular nerve canal.
Osteomyelitis at site 48
Buccal sequestrum and periosteal bone formation evident
Osteomyelitis in anterior mandible
large sequestra and prominent periosteal bone formation at lingual mandibular border
Possible minor salivary gland neoplasm
It is important to separate the tongue from the hard palate during CBCT scans of the palatal tissue, so that the palatal surface is clearly visible.
Calcified mass in spinal canal
Unknown etiology. Medical referral indicated
Possible ameloblastoma in posterior right mandible
Expansile multi-locular lesion, causing extensive root resorption in tooth 46.
Osteochondroma in right mandibular notch region
Incidental finding in implant scan. Osteochondroma almost looks like an accessory mandibular condyle.
Evaluation of endodontic access path relative to lingual retention wire
In order to determine whether wire requires removal to adequately treat dens invaginatus
Secondarily infected cemental dysplasia
forming a sequestrum
Fracture or malformation of C1
Anterior and posterior arches exhibit fracture planes or malformations
Double maxillary antrum + mucocele
Left maxillary sinus appears to be divided into separate anterior and posterior compartments by a complete bony septum. A sinus mucocele may have developed within the posterior compartment secondary to sinusitis, which has caused expansion of the posterolateral wall
Simple bone cyst causing displacement of teeth
Classic features of simple bone cyst (delicately corticated, lack of expansion, preservation of lamina durae, etc.)... But appears to have caused displacement of teeth, which is rare
Gemination and resorption of tooth 48
Accessory cusp formed at distal surface of tooth. Shared root canal system present.
Chronic osteomyelitis
Posterior left mandible
Nerve buccal to 38 and lingual to 48
Cannot make assumptions about contralateral side being symmetric
Repeat of scan 117341, but not on a Vatech scanner
The difference in the appearance (and thus, the resultant diagnosis) is evident.
Artifacts from Vatech CBCT scanner
Knowledge of this type of artifact affects the diagnosis in pathologic cases such as this one
Possible marsupialized OKC with multiple daughter cysts
Incompletely treated lesion with daughter cysts around the roots of the mandibular incisors
Patient head oriented horizontally during scan to avoid metal artifacts between implants
Small field scan produced metal artifacts in region of interest. Large field scan with horizontal head orientation did not have metal artifacts in region of interest
Accessory lingual root of tooth 47
Good example of CBCT for endodontic diagnosis
Large mandibular tori causing symptoms
Tori extend to mid-sagittal plane. Purported swelling and foul taste in mouth.
Ossifying fibroma in left maxilla
Concentric pattern of growth and displacement of adjacent structures. Heterogeneous internal structure.
Tongue piercing causing lingual bone loss in tooth 41
Good example showing the potential sequela of tongue piercings
Ameloblastic fibro-odontome causing impaction of tooth 37
Small calcified entity visible in pericoronal region of tooth 37
Large odotontogenic cyst at impacted tooth 48
Possible odontogenic keratocyst
Permanent tooth causing impaction of deciduous tooth
Tooth 35 is paradoxically located coronal to tooth 75, and is causing vertical impaction of this tooth. This phenomenon is rarely reported in the literature.
Atlanto-occipital fusion
Atlas completely fused with skull base, and concurrent C2-C3 fusion. Rare developmental anomaly.
Perfect example of lateral canal
With a round zone of bone loss around the orifice on the buccal root surface
Recurrent odontogenic keratocyst
Classic recurrent appearnce that has more loculations than the original lesion
Osteochondroma in right temporomandibular joint
Causing facial asymmetry
Unusual expsoure artifact
in central region of scan on a Vatech PaX-i3D
Recurrent lymphoma in posterior right mandible
The infiltrative lesion extending through the mandibular canal is the source of patient's pain in region. It is not a failing endo that is causing the symptoms.
Dens invaginatus in a maxillary molar
Just a fascinating endodontic case. Quite a rare occurrence, but explains the pathologic findings perfectly
Simple bone cyst
Mild lingual expansion. 1 septum
Gemination of tooth 25
Tooth 25 has geminated into distinct teeth located within the buccal and palatal aspects of the alveolar process
Florid osseous dysplasia
One area with an unusual presentation of periapical cemental dysplasia: Mild bone expansion and slight displacement of teeth
Unusually shaped teeth 31 and 41
Possible history of trauma during development
Marsupialized nasopalatine duct cyst
that drains into nasal cavity rather than oral cavity
Recurrent odontogenic keratocyst
Anterior mandible
Maxillary sinus mucocele
Displacement of medial wall of sinus into the middle meatus of nasal cavity
Fibrous dysplasia with simple bone cysts
Irregular expansion of posterior right mandible, heterogeneous bone pattern, cystic entities that scallop around roots, superior displacement of the mandibular canal
Sialolith in right Wharton's duct
Incidental finding. Classic fusiform shape
Fracture of right orbital floor
Interestingly, there are no secondary signs of fracture in the right maxillary sinus.
Healing after bone graft in region of periradicular bone loss of unknown origin
Previous case ID 26389 -- ill-defined lytic bone loss between teeth 21 and 22. Defect now completely filled with bone graft material, and teeth 21 and 22 look normal.
Gemination of tooth 22
Pulp canal systems are partially continuous.
History of hemimaxillectomy
Left maxilla is absent due to a history of squamous cell carcinoma.
Intracranial calcification in left temporal lobe
Medical referral indicated. We don't know what that is.
Possible lateral periodontal cyst interradicular to teeth 34 and 35: Botryoid type
Two small, well-defined,and corticated radiolucencies with two locules are present interradicular to the roots of teeth 34 and 35.
Bilateral central giant cell granulomas
genetic testing required to rule out cherubism
Unusual root canal anatomy
Possible history of internal resorption or a malformation during development
Phleboliths in right infratemporal fossa
Potential vascular lesion
Inverted impacted tooth 35
Unusual orientation of impacted tooth. Typically, mandibular impacted teeth are not inverted
Bone dysplasia causing abnormal development of tooth 24
Bone dysplasia at sites 23, 24, 25. Seems to have caused impaction and abnormal development of tooth 24.
3D measurements on CBCT to determine which lateral incisor is the supernumerary tooth
22a is wider than normal. 22b is narrower than normal. Tooth 12 is shown for comparison.
Color-coding of partially calcified canals in tooth 26
To assist the clinician with determining the posiitons of the canals relative to the access preparation
Iatrogenic damage to tooth 24 by fixation screw
Causing buccal parulis due to devitalization of tooth
Left antral pseudocyst
with interesting presentation because it extends into a sinus loculation that occupies the left maxillary tuberosity
Odontoma associated with tooth 47
Has features of both compound and complex odontoma.
Double horizontal canine impaction in anterior mandible
Probably needs some invisalign
Osteoma in posterior left maxilla
Originating at the left maxillary tuberosity
Unilocular benign radiolucent lesion in posterior 4th quadrant
Most likely an odontogenic keratocyst that displaced tooth 48 into superior aspect of the anterior ramus
Evaluation of a symptomatic implant with no bone loss
Discussion of potential treatment choices for chronic pain after the placement of an implant that appears to have normally osseointegrated
Nevoid basal cell carcinoma syndrome
multiple keratocysts in both arches
Florid osseous dysplasia + history of endo
Affecting teeth 36, 37, and 38. Shows how knowledge of disease progression and appearance alters your expectation for what to expect healing to look like
Sequestered crestal bone in posterior 4th quadrant
Possible bisphosphonate-related osteonecrosis
Good example of normal anatomy in panoramic and cephalometric images
Nothing exciting in this case, but have panoramic, cephalometric, and full skull CBCT images of the same patient at the same time. Great for explaining panoramic and cephalometric anatomy. Also vertical mandibular asymmetry is present in this patient. Can be see as non-coincident inferior mandibular borders in the cephalogram, but confirmed with CBCT imaging.
Large periapical osseous dysplasia
Amorphous radiopacities periapical to teeth 32-43. Another focus apical to tooth 34. Has some expansile features.
Failed osseointegration of implant 23
Great example of the power of periapical radiography. See a radiolucent lining around the implant 23 that is difficult to see in the CBCT. Note that the periapical radiograph also contains a successfully osseointegrated implant 22, which can be used for reasons of comparison.
oblique supracrestal crack in symptomatic tooth 21
Very difficult to spot in grainy scan with motion artifacts
Dentinogenesis imperfecta
Signs: bulbous crowns, cervical constrictions, obliterated pulp chambers, abraded enamel, periapical rarefying osteitis
Odontome palatal to tooth 11
at an early stage of formation . Could be a complex or compound odontome
Visible fracture plane on non-endodontically treated tooth 46
Patient was symptomatic, tooth sleuth positive, no periapical or periradicular pathology
Florid osseous dysplasia in anterior mandible
causing mild buccolingual expansion of the alveolar bone
Erosive middle ear lesion
Loss of ossicular chain, soft tissue mass in aditus ad antrum and mastoid air cells
Fibrous dysplasia in anterior right mandible
Producing mandibular asymmetry
Adenomatoid odontogenic tumor
Histopathologic diagnosis
Visualization of blood vessels lining the right maxillary sinus wall
Wide diameter vessel is clinically significant if lateral window sinus lift is being considered
Dilacerated root and PCD will impede implant placement
PCD and dilacerated root at site 24 prevents implant placement at site 23
Osteomyelitis in posterior left mandible
Sequestered bone present
Possible mixed odontogentic tumor in anterior maxilla
Mutliple small calcifications are scattered within the predominantly radiolucent lesion
Potential skull base lesion - incidental finding in implant scan
Radiolucency in left greater wing of the sphenoid bone
gemination of tooth 11
Fibrous dysplasia of right sphenoid bone
Good example of fibrous dysplasia involving skull base
fractured alveolar process in posterior Q1
secondary signs of fracture in right maxillary sinus
Large odontogenic cyst associated with impacted tooth 23
causing displacement of surrounding structures
Possible central odontogenic fibroma
Classic palatal defect
Erosive lesion in right middle ear?
Malleus and incus not visualized. Some soft tissue in middle ear. Possible cholesteatoma?
Large right submandibular sialolith
Beautiful concentric lamellar pattern
Double lesion at tooth 12
One current lesion and one prior lesion. Awaiting biopsy results
Unicystic ameloblastoma in 7 year old
confirmed via histopath report pre-imaging
converted medical CT scans to isotropic voxels
allows report to be made with carestream viewer
Probable healing simple bone cyst
Interesting internal bone pattern
Example of situation where following an imaging protocol would have improved the scan. This scan was an 8x8cm scan, but the region of interest is just tooth 27 for an indirect sinus lift. The scanner position was not adjusted prior to the scan to center the field on tooth 27
. A smaller field could have been selected. The scan was not checked to ensure that the region of interest was fully captured. All these things could have been addressed with a scanning protocol that is customized for each patient, rather than setting the scanner in one position and one size, and hoping that it will accommodate most of one's scanning needs.
Miliary osteoma cutis
Multiple punctate radiopacities in bilateral facial skin
Osteomyelitis in anterior maxilla
Sequestered bone fragments in anterior 2nd quadrant
No translation of condylar heads in mandibular open position
26mm maximal opening, with zero translation of condylar heads
Lesion in right zygomatic process of maxilla and zygomatic bone
Benign cyst or tumor
Foreign object in right nasal cavity
surrounded by what appear to be dystrophic calcifications
A bridge of impacted teeth...
Teeth 15, 17, and 18 appear to form a bridge of impacted teeth in the right maxillary sinus. Likely secondary to a history of facial trauma as a child.
Radiolucency apical to tooth 24 in panoramic image
definitively diagnosed as sinus loculation with CBCT
Large compound odontoma
Compound odontoma in anterior left maxilla, causing impaction of tooth 23.
Large complex odontoma
Large radiopaque mass in posterior right mandible. Thin uniform radiolucent lining. Internal radiolucent channels.
Possible neural tumor
Fusiform enlargement of the left inferior alveolar nerve canal near the mental foramen region
Large radiopaque mass superimposed over right middle cranial fossa
in panoramic image.
Technetium bone scan produced a region of high intensity in 38 region
The retained root tip and restorative material is a red herring. The actual source of the hot spot is a bone dysplasia, which is partially captured in the scan
apparent cystic lesion in right condylar neck on panoramic image
CT confirms no lesion. But it looks so convincing on pan
Osteomyelitis in left mandible + generalized punctate radiolucencies
Post-radiation therapy? Malignancy?
Alveolar process fracture
Anterior maxillae
Radicular groove and unfilled lingual canal visible
CBCT informs the endodontic diagnosis - implications for retreatment
Very extreme variant of dens invaginatus in tooth 12
An irregularly shaped, severely malformed root canal system is present within the entire root length of tooth 12
Multiple impacted teeth stacked on top of each other in posterior 1st quadrant
Sinus pneumatized around it
healing ossifying fibroma
interesting appearance of inferior alveolar nerve canal in post-treatment region
This scan shows the value of not having patient motion in a scan
TMJ closed views have motion , which could lead ot misdiagnosis of the bone. TMJ open views do not have patient motion artifacts, and the bone is clearly visible for accurate diagnosis
recurrent central odontogenic fibroma
prior scan 17814
Right inferior alveolar nerve canal completely enveloped by roots
Vertically impacted tooth 48: mesial and distobuccal roots completely envelop the right inferior alveolar nerve canal
unusual shape of lesion at site 38
Possible cause of cellulitis
Very large stafne defect
in anterior left mandible
Infiltrative soft tissue mass in left infratemporal region
extends through posterior wall of left maxillary sinus - likely a malignancy
Lesion in right condylar head and neck
Must find out diagnosis from oral surgeon
Atypical periapical cemental dysplasia?
Irregular radiopacity attached to the distal root of tooth 46 which is causing root resorption.
Detached prominent genial tubercles
Possibly fractured and healed with non-union.
Fibromyxoma
in posterior right mandible
sequential scans of florid osseous dysplasia
Repeated scan in Sept 2015 - can compare this scan to future scan directly
overlapped mandibular incisors
2 rows of teeth
maxillary bone reduction guide
with option of 2 types of bone reduction guide "cap style" and regular style.
Malformation in the left anterior maxilla
possibly congenital malformation
overexposure artifact at maxillary midline
Kodak 9000 scanner
complex mucosa-supported guided surgery case
mucosa guides for max and mand, 10x implants, 7x fixation pins. Articulating guides that match dentures.
possible soft tissue osteoma
Lingual to tooth 33
Impacted tooth 48 and fractured root of tooth 47
A great impacted wisdom tooth case
Segmental odontomaxillary dysplasia
Right maxilla
Referral was for a "cyst"
It is actually a bone dysplasia
Possible Melorheostosis
Left mandible: sclerosing bone dysplasia, pai n,
simplant segmentation of perfect dentition
Perfect segmentation. Perfect teeth
There is multilocular lesion in right temporal bone
petrous portion of right temporal bone
pre-surgical and post-surgical skulls overlaid on each other
3D interactive models at: https://canaray.com/canaray/convert/stl_multi/attachment.file.b41ce9e46f3298fb.38313632325f53686f6e655f446f6f6e5f323031352d30372d33315f736b756c6c5f706f73745f616c69676e65642e73746c.stl/attachment.file.b94e004153d6967f.36313134395f53686f6e655f446f6f6e5f323031342d31302d30325f736b756c6c5f7072655f616c69676e65642e73746c.stl
foreign object in sinus that was not in prior scan
has a very fabric-like apparance...may be a piece of gauze or membrane material upon which calcification is occurring
teeth fragments embedded in tongue
Something to look at whenever you are having a bad day to remind yourself that your day isn't so bad
Radicular cyst at early stage of healing
in mid 2nd quadrant
Perfect example of PDL space widening from occlusal trauma
on tooth 13
Simplant of Compound odontome
Segmented simplant of odontome
PCD with Tc bone scan results showing uptake in right mandible
marsupialized nasolabial cyst
"unusual noise on palpation"
benign bone-forming neoplasm in left maxilla
possible ossifying fibroma
enamel pearl or accessory cusp in furcal region of palatal root
Produced unusual canal anatomy in this region and resulted in devitalization of the tooth
good example of gemination
geminating supernumerary tooth in q4
Good full skull scan
Good for segmenting, and using as a teaching tool for anatomy
ossifying fibroma
left mandible
Both wisdom teeth completely enveloped by roots of 38 and 48
high risk of iatrogenic damage
incidental bone dysplasia
in an implant case
Tooth in right nasal cavity
not embedded in bone. Malformed: conforms to border of nasal cavity
Beat Canaray - here's a scan. Show us what you've got
Open scan . Make your interpretation. Compare it to Canaray, and see if you did a better job.
ususual implant design - implants placed in France
causing extensive destruction of surrounding bone
fibrous dysplasia preventing eruption of tooth 13
in first quadrant.
artifact on tooth 14 mimics a root fracture
but no widening of PDL space or any signs of endodontic issues
there is a persistent fistula at site 33
we did not see it. This was discovered by the clinician surgically during implant treatment. Tooth 32 appears normal
unusual anatomic variant of inferior alveolar nerve canal
Trish thinks this is an OKC. Milan thinks Dentigerous cyst
we should ask for the pathology results.
Perfect scan
This is what perfect scan quality looks like: no motion. no metal. well-captured region of interest.
demonstrates rough version of prosthetic result
to help decide whether to keep the implant as is or reposition it
radicular cyst from lateral canal
clearly visible lateral canal
Was retreated by the endodontist. Long narrow 10mm pocket on MB root
Was it a fracture of the MB root in the first place? Or did a fracture occurr since scan?
original CBCT was small field. We made a medium field scan to get full extent of lesion
totally changes the diagnosis
would be a good candidate for a biopsy guide
3D printed guide that gives you biopsy outline or trephine approach path.
clinical photos with small camera
example to use for colour
Patient's duplicate dentures did not fit . She could not bite down properly
We adjusted the denture in our lab, and finished the job properly. No charge, no fuss. This is why people choose Canaray: We save everybody time and trouble.
really clear scan
from carestream 9300 - comparable to morita
hypoplastic maxillary sinuses
Nasal cavity extends into the area normally occupied by sinuses
perfect ceph
All structures in maxilla and mandible perfectly aligned
duplicate report of 62580
let's see how similar our reports are. We did this twice independently
this seems like it has 2 canals
missed while reporting. Is there resorption in the bifurcation?
biopsy came back as odontogenic keratocyst
good report for CAOMR
This is an example of a case where the impression scan doesn't match the stone scan
Impression scans are not reliable. CoDiagnostix overlay shows that impression scan is not reliable when compared to the stone scan
example of case with simulated Le Fort 1 procedure
simulated in CoDiagnostix
example of a case where implant for report is done in simplant
maybe a potential future way of doing this.
overexposure artifact at mandibular midline
should've been taken at a lower kV. This is a classic overexposure artifact that seems to be unique to the kodak 9000
Nose implant extends into apical regio of tooth 21
If a buccal bone graft is done at site 21, there is a potential risk of changing the shape of the nose.
Excess graft material in left sublingual region
Good case for differential diagnoses of sublingual calcifications.
dentigerous cyst on tooth 14
Displacement into sinus
good example of successful marsupialization
in posterior 3rd quadrant
dilated odontome in posterior 4th quadrant
affecting development of root of mesioangularly impacted tooth 48
morphologic variant of root 12
complicated endo case
Tooth 18 developed within sinus septum
unusually positioned impaction
complex odontoma
mid 4th quadrant
compound odontome
preventing eruption of tooth 23
fixation screw impinges upon unerupted tooth 15
preventing eruption of tooth 15
healing simple bone cyst
uniform granular structure of healing bone
good example of a digital case - we have simplant and codiagnostix
Also, the STL model is from a digital impression (iTero). Guide made in CoDiagnostix, using nice segmentations from Simplant.
implants impinge upon right IAN
the nerves are not at the same height on the right and left
perfect pan
example of perfect pan technique
osteomyelitis in posterior 3rd quadrant
history of radiation treatment many years ago.
Buccal bone loss at tooth 48
Great example of a finding that is only visible on CBCT, not on plain films
Pellet from Pellet gun embedded in left cheek
incidental finding
Osteoradionecrosis or osteomeylitis of left mandible
History of radiation treatment 30 years ago
severe dilaceration of tooth 21
very curved root
implant displaced into left maxillary sinus
There is also an oroantral fistula
osteomyelitis in 4th quadrant
plus slight impingement of implant 46 on nerve
gingival lesion producing reactive periosteal bone formation at tooth 21
The gingival tissue appears to be the primary lesion
soft tissue swelling around tooth 33 that splays teeth
mild erosoin of alveolar process
periapical cemental dysplasia on mandibular teeth
with simple bone cyst in anterior 3rd quadrant
Good example of simplant for maxilla and mandible
with STL fusion and virtual teeth
Surgical confirmation of fracture on tooth 24
The fracture detected in the CBCT was confirmed surgically
Unfilled MB2 canal in tooth 16
example of an endo case report from Canaray. The imaging for this case was performed at Canaray Mississauga
huge tonsillolith
in right palatine tonsil
Incomplete gemination of tooth 35
Tooth 35 exhibits incomplete gemination resulting in buccal and lingual segments that are fused by a central isthmus and demonstrate pulpal communication
Patient imaged for 23/24
But significant findings are present on teeth 11, 21, 24, which significantly alters the treatment plan
possible malignancy on 36DLi
lytic bone loss present.
Root resorption and history of trauma
Multiple teeth in the mandible exhibit external resorption. The mandible has an unusual shape due to the history of fracture.
dentigerous cyst on tooth 48
Minor salivary gland tumor
at posterior left hard palate
Good example of 2 arch case for simplant
Note the scan of the patient's teeth in occlusion, which allows virtual planning with virtual teeth instead of a waxup
This scan was done twice at different scan settings
The 2nd scan at lower KV settings produced a significantly better image at the mandibular midline
Osteoma on C1
Incidental findng of osteoma extending from C1
early osteosarcoma in left zygomatic bone
soft tissue mass overlies it clinically
amazing impaction of teeth 13 and 23
horizontal impactions that are oriented buccally
embedded shotgun pellets
metal balls embedded within facial soft tissue
florid osseous dysplasia
anterior mandible and third quadrant
drainage tubes in frontal sinuses
history of sinus surgery
oligodontia
retained deciduous teeth
TMD with multiple ostoephytes
bilateral issues with temporomandibular joints
scan of a failing implant and an integrated implant
easy way of comparing if it is failing or not
marsupialized OKC
with a seprated loculation that will result in a recurrence
marsupialised odontogenic keratocyst
trapped loculation visible
dens invaginatus on teeth 12 and 22. Dentigerous cyst on tooth 13
Multiple interesting findings
multiple cysts around wisdom teeth
possible nevoid basal cell carcinoma syndrome
Large odontogenic cyst in posterior 4th quadrant
increased risk of nerve damage during surgical removal
Possible hemangioma
multilocular lesion in posterior 3rd quadrant
Bilateral central giant cell granulomas in mandible
Cherubism
exposed bone of torus adjacent to tooth 17
long standing bone exposure
midline cyst in anterior maxilla
not a nasopalatine duct cyst
Periosteal bone formation around chin implant, and periapical cemental dysplasia
should not be misdiagnosed as a pathologic entity
is the pain caused by the retained wire?
no, the nerve has an unusual morphology
example case for lining up implants with guide
for processing, match this for offset guides.
This was a myxoma
unusual appearances of apices of teeth
early signs of internal resorption?
lingual nerve visible adjacent to tooth 38
unusual presentation where both nerves are visibile around the roots of tooth 38
shows the lateral canal that is the source of the patient's symptoms
3D video shows lateral canal clearly
good trick case in Q3
Normal variant of trabecular pattern. But it looks like a myxoma (very straight septae)
unfilled buccal canal on tooth 15
This is why endodontists choose canaray
post-surgical confirmation of fracture
from flap lifted by Dr. Pakozdi
involuted radicular cyst
bifid condyles biliaterally
textbook case
subcutaneous calcification in right cheek
benign tumor ? pilomatricoma
This is an easy case to learn simplant on
simple segmentations
ossifying fibroma
History of surgery in the area. Also: rarefying osteitis on tooth 46
recurrent cyst
Perhaps a keratocyst, with recurrence at 2 separate foci
The difference between periodontal bone loss from a root fracture and normal periodontal bone loss
46 has a root fracture, 47 has normal periodontal bone loss
cyst in posterior 2nd quadrant
Nice 3D video with segmentation of cyst/tumor
2x periapical cemental dysplasia
Entity at site 45 has an unusual presentation
complex odontome
superior to tooth 48. Mandibular nerve courses through mesial and distal foramina of tooth 48.
possible ossifying fibroma in nose
Fibro-osseous lesion in left lateral wall of nose.
great diagnostic use of CBCT for endo
Finding an unusual 2nd canal on tooth 44 based on morphology
History of multiple sinus surgeries
Post-surgical sinus appearance
Possible low-grade malignancy at site 48
Irregularly shaped radiolucency
large PCD
Large focus of periapical cemental dysplasia
dentigerous cyst on tooth 22
The resulting displacement of tooth 22 is causing an impaction of tooth 23
Impaction caused by sinus pneumatization
Tooth 24 could not erupt normally because
reimplanted 21
shows signs of external root resorption
Hyperplastic left coronoid process
Left coronoid process extends beyond the superior border of the zygomatic arch
Facial swelling caused by tooth 34
Necrotic pulp on tooth 34 caused rarefying osteitis that drained buccally and caused facial swelling.
complicated course of right mandibular nerve
IAN tooth courses between mesial roots of tooth 47, buccal to distal root of tooth 47, and lingual to the roots of tooth 48
inferior nasal conchae missing, tumor in right maxillary sinus
unusual appearance of nasal cavity: devoid of turbinates.
odontome and PCD
odontome between teeth 42/43 and PCD apical to tooth 44
second canal in tooth 31
Detected in 1st scan. Treatment imaged in 2nd scan
narrowed airway
Osteophyte formation on the cervical vertebrae has reduced the oropharyngeal airway space
fused 11 and 12
Fusion via cementum preventing orthodontic tooth movement
PCD
multiple regions of periapical cemental dysplasia, plus residual PCD in extraction site 38
osteonecrosis
in mandible
left mandibular ramus finding
small cystic expansile radiolucency
supernumerary teeth
with tiny odontomes between teeth 33 and 34
cleft palate case
Left cleft palate
unusual lesion in 4th quadrant
Thick corticated periphery with radiolucent internal structure