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Case 105962

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Referral category

Troublesome / painful / cracked tooth (Endodontic)

Region of interest

36

Referral reason

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Canaray 105962

1. Persistent region of low bone density in periapical region of tooth 36

A persistent zone of low-density bone is present in the periapical region of tooth 36. This likely represents a zone of immature periapical cemental dysplasia that is associated with a larger region of florid osseous dysplasia, which suggests that complete radiographic resolution of the apparent lesion in the periapical region of the tooth cannot be expected. Therefore, the diagnosis of endodontic healing in this case would be based on the clinical presence or absence of symptoms.

Axial views of tooth 36

These axial cross-sectional images demonstrate the low-density granular bone that is present in the periapical region of tooth 36. This most likely represents an immature focus of periapical cemental dysplasia. The low bone density within this cemental dysplasia would not be affected or altered by the endodontic obturation of tooth 36. Therefore, the radiographic appearance of the periapical region of tooth 36 would not be a useful diagnostic tool for the endodontic evaluation of tooth 36 in this particular case.

Buccolingual views of tooth 36

These buccolingual cross-sectional images demonstrate the normal appearance of the alveolar bone on the buccal and lingual surfaces of the roots of tooth 36.

Mesiodistal views of tooth 36 demonstrating extensive cemental dysplasia, known as florid osseous dysplasia

These mesiodistal cross-sectional images demonstrate the multilocular and heterogeneous appearance of the granular bone in the periapical region of tooth 36. Overall, this radiographic appearance is suggestive of a broad zone of partially mature periapical cemental dysplasia, which is also known as florid osseous dysplasia when it occupies a large proportion of the mandibular body.

2. Immature cemental dysplasia tooth 37

An immature focus of periapical cemental dysplasia is present at tooth 37. This entity is comprised of low-density bone internally, and is surrounded by a delicately corticated sclerotic rim, which may suggest the co-presence of a simple bone cyst, which commonly occurs in association with periapical cemental dysplasia.

Axial views of tooth 37

The low-density granular bone in the periapical region of tooth 37 is evident in these images. Based on the diagnosis of florid osseous dysplasia, this is most likely a non-significant incidental finding, and is not an indication for endodontic treatment of tooth 37.

Buccolingual views of tooth 37

These buccolingual cross-sectional images demonstrate the normal appearance of the alveolar bone on the buccal and lingual surfaces of the root of tooth 37. The apical regions of the root of the tooth appear slightly blunted, which is suggestive of a history of stunted root development. This slight malformation of the root is not caused by periapical cemental dysplasia.

Mesiodistal views of tooth 37

These mesiodistal cross-sectional images demonstrate the mature cemental dysplasia and possible simple bone cyst that are present in the periapical regions of teeth 36, 37, and 38.

3. Immature cemental dysplasia apical to tooth 38

An immature focus of periapical cemental dysplasia is present in the periapical region of the root of tooth 38. This entity has a well defined delicately corticated periphery, which is suggestive of a possible associated simple bone cyst. Tooth 38 likely remains vital, and does not require any endodontic treatment.

Axial views of tooth 38

These axial cross-sectional images demonstrate the periapical epicenter of the immature cemental dysplasia at tooth 38.

Buccolingual views of tooth 38

These buccolingual cross-sectional images demonstrate the normal appearance of the alveolar bone on the buccal and lingual surfaces of the roots of tooth 38.