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Troublesome / painful / cracked tooth (Endodontic)
Region of interest
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1. Benign mixed odontogentic tumor or cyst at maxillary midline
A well-defined, predominantly radiolucent entity with a cystic shape is present at the maxillary midline. This entity has caused a significant buccal expansion of the alveolar process, and extends around the nasopalatine duct. Scattered amorphous radiopacities are present within the entity, which suggests that it has innate calcification potential. The roots of teeth 11 and 21 have been splayed but do not exhibit any resorption. The entity extends around the periapical regions of teeth 11, 12, 13, 21, and 22. However, these teeth to not appear to be the source of the lesion. The most likely diagnosis is a benign mixed odontogenic tumor or cyst, such as a calcifying odontogenic cyst.
Axial views of anterior maxilla
These axial cross-sectional images demonstrate the extensive buccal expansion of the alveolar process at the maxillary midline, as well as the buccal position of the cystic entity relative to the nasopalatine duct. The displacement of the roots of teeth 11 and 21 is evident in these images, as is the absence of any root resorption. Small calcifications with density similar to that of trabecular bone are present in the posterior left aspect of the lesion.
Coronal views of anterior maxilla
These coronal cross-sectional images demonstrate the extension of the predominantly radiolucent benign lesion around the buccal surface of the nasopalatine duct. Note the splayed roots of teeth 11 and 21, as well as the absence of any root resorption.
Normal tooth 13
The apical foramen of tooth 13 appears normal radiographically. The benign odontogenic lesion that originates in the anterior maxilla extends onto the mesiopalatal surface of the apical third of the root of tooth 13, but has not affected the tooth otherwise.
Normal tooth 12
Tooth 12 appears normal radiographically, and has not been significantly affected by the benign lesion that is developing apically to it. The lamina dura has been lost in the periapical region of tooth 12, but the tooth appears normal otherwise.
Distally displaced root of tooth 11
The root of tooth 11 has been distally displaced by the benign odontogenic lesion that originates at the maxillary midline. No root resorption or damage has occurred to tooth 11. The lamina dura has been lost on the mesial and apical surfaces of the root of tooth 11.
Distally displaced root of tooth 21
The root of tooth 21 has been distally displaced by the benign odontogenic lesion that originates at the maxillary midline. No resorption or damage has occurred to tooth 21. However, the lamina dura has been lost on the mesial and apical surfaces of the root of the tooth.
Normal tooth 22
Tooth 22 does not exhibit any intrinsic periapical pathology. However, the benign odontogenic lesion extends onto the mesial surface of the apical region of the root. No root resorption or damage has occurred to tooth 22
2. Retained resorbing roots of tooth 48
The roots of tooth 48 are retained, and appear to be resorbing. Although the trabecular pattern in the region surrounding the retained roots is slightly sparser than that of the adjacent bone, no specific pathology is radiographically evident. This bone pattern is not suggestive of the presence of an active lesion.
Mesiodistal views of posterior fourth quadrant
These mesiodistal cross-sectional images demonstrate the normal periodontal ligament spaces that surround the retained resorbing roots of tooth 48. The surrounding trabecular bone is of slightly lower density, but has a normal overall appearance. The inferior alveolar nerve canal has not been affected.