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Troublesome / painful / cracked tooth (Endodontic)
Region of interest
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1. Palatal bone defect apical to tooth 12
A fairly well-defined partially corticated defect is present at the palatal aspect of the alveolar process in the periapical region of tooth 12. No palatal cortical plate is present in this region, and the defect extends around the apical region of the rarefying osteitis originating at tooth 12. No soft tissue swelling is radiographically evident. The most likely diagnosis is a healed post-treatment appearance of a previous large periapical defect originating at tooth 12.
2. Periapical rarefying osteitis at tooth 12
A small focus of periapical rarefying osteitis is present at tooth 12, which suggests that the endodontic treatment is failing. The rarefying osteitis has a well defined corticated periphery, which abuts a separate radiolucent defect in the periapical region of the tooth, and has produced an unusual appearance in the mesiodistal view. No signs of root fracture are present at tooth 12. No unfilled canals are present.
Axial views of tooth 12
These axial cross-sectional images demonstrate the well-defined periapical rarefying osteitis at tooth 12, as well as the presence of a second independent lesion, which is more apically positioned, and is continuous with the palatal aspect of the alveolar process.
Mesiodistal views of tooth 12
These mesiodistal cross-sectional images demonstrate the two independent lesions that are present in the periapical region of tooth 12. One lesion is associated with the root apex of the tooth and is secondary to a failing endodontic treatment. The second lesion is continuous with the attached palatal gingiva, and may be a remnant of a prior large healed periapical lesion.
Buccolingual views of tooth 12
These buccolingual cross-sectional images demonstrate the well defined corticated periphery of the periapical lesion associated with the root apex of tooth 12, as well as the loss of the palatal cortical plate adjacent to the second apically positioned radiolucent region in this region. The palatal gingival tissue does not exhibit any thickening adjacent to the radiolucent bone defect, which suggests that this represents a healed post-treatment appearance of a prior lesion.