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Referral details

Case 131476

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Referral category

Troublesome / painful / cracked tooth (Endodontic)

Region of interest

Quadrant 2

Referral reason

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1 Files Info

Canaray 131476

Volume rendering of 2nd quadrant

MP4 Video: Suitable for Apple, Windows and mobile devices, 2nd quadrant

1. Fixation screw impinges upon mesiobuccal root of tooth 26

A surgical fixation screw impinges upon the apical third of the mesiobuccal root of tooth 26. A broad zone of rarefying osteitis originates in the furcal region of tooth 26 and is likely secondary to the iatrogenic damage of the endodontically treated tooth by the fixation screw. The epicenter of the lesion appears to be the furcal surface of the apical half of the mesiobuccal root of the tooth. No signs of fracture are present in tooth 26. No unobturated canals are radiographically evident. Based on this radiographic appearance, the most likely source of the lesion is a failing endodontic treatment in the mesiobuccal root of tooth 26 secondary to iatrogenic damage by the fixation screw.

Orthogonal views of tooth 26

These orthogonal cross sectional images demonstrate the epicenter of the rarefying osteitis on the furcal surface of the apical half of the mesiobuccal root of tooth 26. The crestal bone associated with the tooth appears normal. No signs of root fracture are radiographically evident. The palatal root of the tooth is not the epicenter of the lesion, which suggests that the palatal root has been secondarily affected.

Axial views of tooth 26

These axial cross sectional images demonstrate the impingement of the surgical fixation screw upon the apical third of the mesiobuccal root of tooth 26. The rarefying osteitis that is present in the periapical regions of the roots of the tooth is also evident in these images. Note the normal appearance of the alveolar bone surrounding the coronal thirds of the roots of the tooth. The mesiobuccal root of tooth 27 has been secondarily affected, and is not the source of any pathology.

Buccolingual views of tooth 26

These buccolingual cross sectional images demonstrate the end of the fixation screw upon the mesiobuccal root of tooth 26. Note the rarefying osteitis that is present in the furcal region of the tooth at the levels of the apical halves of the roots.

Mesiodistal views of tooth 26

These mesiodistal cross sectional images demonstrate the periapical rarefying osteitis at tooth 26, as well as the extension of this rarefying osteitis on to the mesial surface of the apical two thirds of the mesiobuccal root of tooth 27. Note the intact alveolar bone around the coronal thirds of the roots of tooth 26, which confirms that the tooth is not fractured.

2. Secondarily affected tooth 27

The rarefying osteitis originating at tooth 26 extends onto the mesial surface of the apical two thirds of the mesiobuccal root of tooth 27. No periapical pathology is present at tooth 27, which suggests that this tooth is secondarily affected by the lesion originating at tooth 26

3. Mild mucositis of left maxillary sinus

The left maxillary sinus exhibits mild mucositis, which represents an incidental finding with no clinical significance.