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Referral details

Case 107371

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Referral category

Troublesome / painful / cracked tooth (Endodontic)

Region of interest

Maxillary anterior

Referral reason

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Canaray 107371

1. Rarefying osteitis on tooth 21

There is rarefying osteitis located periapical to tooth 21. The buccal cortex overlying this region appears thinned and may be partially dehiscent. The remaining periradicular bone appears normal. These findings suggest that tooth 21 may be devitalized, but clinical vitality testing is necessary to confirm this finding.

Heavily calcified root canal system in tooth 21

The root canal system of tooth 21 appears heavily calcified and may not be negotiable. Based on what can be visualized, this tooth appears to have a single, centrally positioned root canal.

Axial views of tooth 21

These axial cross-sectional images demonstrate that tooth 21 has a single, centrally positioned root canal system. However, this root canal system appears heavily calcified and may not be negotiable.

Buccolingual views of tooth 21

These buccolingual cross-sectional images demonstrate that the buccal cortex overlying the root apex of tooth 21 appears thinned and may be partially dehiscent. The contiguous palatal cortical plate appears thinned, but remains intact.

Mesiodistal views of tooth 21

These mesiodistal cross-sectional images demonstrate the periapical epicenter of rarefying osteitis associated with tooth 21. The remaining periradicular bone appears normal. There are no radiographic signs of root fracture in this tooth.

2. Osseous dysplasia associated with impacted tooth 24

There is a heterogeneous area of abnormal granular bone located in the left maxilla, just distal to tooth 23, in site 24, and also periapical to tooth 25. The buccal and palatal surfaces of the alveolar process appear irregularly expanded in this region, but not about a fixed epicenter of growth. The floor of the maxillary sinus located periapical to tooth 25 also appears irregularly elevated, but remains intact. A severely malformed and partially resorbed root of the unerupted tooth 24 appears to be present at site 24, within this area of abnormal bone pattern. Hypercementosis is also evident around the root of tooth 23, which extends distally to become continuous with the residual root of tooth 24. These findings are suggestive of a focus of osseous dysplasia associated with teeth 23, 24, and 25. The osseous dysplasia may have caused impaction and malformation of tooth 24. Continued radiographic monitoring is recommended to assess if this entity demonstrates any propensity for further growth.

Axial views of site 23, 24, 25

These axial cross-sectional images demonstrate the presence of a region of irregular, granular bone pattern located at site 24 and periapical to tooth 25. The malformed and partially resorbed root of an impacted tooth 24 is also evident within this region of abnormal bone pattern. Hypercementosis is observed around the root of tooth 23, which appears to be continuous with the residual root of tooth 24.

Buccolingual views of the sites 23, 24, 25

These buccolingual cross-sectional images demonstrate that the buccal and palatal surfaces of the alveolar process of sites 24 and 25 appear slightly expanded in an irregular pattern. The contiguous buccal and palatal cortical plates appear thinned, but remain intact.

Mesiodistal views of sites 23, 24, 25

These mesiodistal cross-sectional images demonstrate the presence of a malformed and partially resorbed root retained within the alveolar process of site 24. This retained root appears continuous with the hypercementosis stemming from the distal root surface of tooth 23. Also note the irregular, granular bone pattern located in the alveolar process of site 24 and periapical to tooth 25, which indicates the presence of a bone dysplasia.