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Troublesome / painful / cracked tooth (Endodontic)
Region of interest
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1. Cystic lesion with possible origin in palatal gingiva
A well-defined, unilocular, radiolucent cystic lesion is present at the palatal aspect of the left maxillary alveolar process adjacent to teeth 22, 23, and 24. This entity has caused significant expansion of the palatal gingiva in this region. The lesion has also produced a dome-shaped defect in the palatal aspect of the alveolar process, which has secondarily infected the roots of teeth 23 and 24. Overall, this radiographic appearance is suggestive of a cystic lesion originating within the palatal gingiva. The possibility of the presence of a palatal mucocele or minor salivary gland tumor should be ruled out. This lesion does not appear to have an endodontic origin.
Orthogonal views of anterior second quadrant
These orthogonal cross-sectional images demonstrate the soft tissue cystic lesion that is present within the palatal gingiva in the anterior second quadrant. The displacement of the adjacent alveolar bone is evident in these images.
2. Vertical bone loss at tooth 25P: possible root fracture
Tooth 25 exhibits vertical periodontal bone loss on its palatal surface which extends to the mid-root level of the tooth. This bone loss is suggestive of a possible fracture on the palatal surface of the root of the tooth. No periapical pathology is present, which suggests that the endodontic obturation of the tooth has been successful.
3. Secondarily affected tooth 24P
The cystic lesion originating in the palatal gingiva extends laterally into the periapical region of the palatal root of tooth 24. This radiolucent lesion does not appear to originate at tooth 24, which suggests that the tooth has been secondarily affected. The buccal root of tooth 24 appears normal radiographically. No root resorption is evident.
4. Secondarily affected tooth 23
The soft tissue cystic lesion extends to the palatal surface of the apical half of the root of tooth 23. This suggests that tooth 23 is merely secondarily affected by the cyst, rather than a potential source of the pathology in this region. The other periradicular regions of tooth 23 appear normal. No root resorption is evident on tooth 23.
Normal tooth 22
Tooth 22 appears normal radiographically. The periodontal ligament space appears thin and uniform, and the lamina dura is intact. There are no signs of pathology, resorption, or root fracture. The palatal cystic lesion does not affect the root of tooth 22.
5. Vertical bone loss at tooth 14
Tooth 14 has been partially captured in this imaging volume. Vertical bone loss is present on the furcal surface of the palatal root, from the level of the alveolar crest to the apical third of the root. The palatal root does not exhibit any periapical pathology. This appearance is suggestive of a root fracture on the furcal surface of the palatal root of tooth 14. The lingual cortical plate has been lost at the coronal third of the root. The periapical periodontal liagment space of the buccal root appears widened. Based on what can be visualized, it appears the buccal root is incompletely obturated. Extruded endodontic sealer is evident at the palatal apex, which is a non-significant incidental finding.
6. Mild mucositis of left maxillary sinus
The left maxillary sinus exhibits mild mucositis, which represents an incidental finding with no clinical significance.
7. Palatal torus
A palatal torus is present in the midline of the hard palate. This is an incidental finding with no clinical significance.