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Case 104364

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Referral category

Troublesome / painful / cracked tooth (Endodontic)

Region of interest

23 24

Referral reason

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Canaray 104364

Axial views of tooth 26

Buccolingual views of tooth 26

Mesiodistal views of tooth 26

1. Thin buccal bone overlying implant 22

The buccal cortical bone overlying the coronal half of the implant at site 22 is thin and may be partially dehiscent. The remainder of the implant appears osseointegrated.

2. Peri-implant bone loss on tooth 23M+D

Mild peri-implant bone loss is evident along the mesial and distal aspects of the coronal third of the implant placed at site 23. The mesial and distal peri-implant bone is not well visualized in this imaging volume due to the presence of beam hardening artifacts. However, the periapical radiograph demonstrates the presence a soft tissue lining around the circumference of this implant fixture. These findings suggest that the implant 23 has failed to osseointegrate.

Axial views of implant 23

These axial cross-sectional images demonstrate that the implant 23 is centrally positioned within the alveolar process of site 23.

Buccolingual views of implant 23

These buccolingual cross-sectional images demonstrate that the buccal and palatal cortical plates overlying the implant 23 appear to be intact. The implant apex is not in close proximity to the sinus floor.

Mesiodistal views of implant 23

These mesiodistal cross-sectional images demonstrate the presence of mild peri-implant bone loss along the mesial and distal aspects of the coronal third of the implant 23. The periapical radiograph demonstrates a soft tissue capsule lining the implant circumference, which suggests the presence of failed osseointegration.

Normal site 24

Site 24 appears normal radiographically, and demonstrates a normal trabecular architecture. There are no radiographic signs of pathology that would contraindicate regional implant placement.

3. Rarefying osteitis on tooth 26MB

There is rarefying osteitis located periapical to the mesiobuccal root of the endodontically-treated tooth 26. The overlying sinus floor is elevated and thinned adjacent to this region. The existing obturation in the MB1 canal of this tooth ends at the mid-root region. An unfilled MB2 canal is also evident. The obturation in the distobuccal root is not positioned within the distobuccal canal, but rather along the mesiopalatal surface of the coronal third of this root, which infers the possibility of a root perforation. However, there is no evidence of periapical or periradicular pathology in the distobuccal root of this tooth, despite these findings. The obturation of the palatal root extends to the root apex, and the palatal root demonstrates a normal post-treatment appearance. These findings suggest persistent endodontic pathology in association with incomplete obturation of tooth 26.

4. Vertical bone loss on tooth 27D

Vertical bone loss is evident along the distal aspect of tooth 27, which extends from the alveolar crest to the mid-root region. The crestal epicenter of this bone loss suggests a periodontal etiology.

5. Moderate mucositis in left maxillary sinus

Moderate mucositis is present in the left maxillary sinus. This is an incidental finding with no clinical significance.

Sagittal views of the left maxillary sinus

These sagittal cross-sectional images demonstrate the presence of moderate mucositis in the left maxillary sinus, which may slightly impede a sinus lift procedure.

6. Transverse ridge apical to site 27

A transverse ridge is present along the floor of the maxillary sinus apical to site 27, which may impede a sinus lift procedure in this region.