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Case 131754

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Disease / syndrome / tumor / condition

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Pathology

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Canaray 131754

1. Revision: osseous dysplasia in posterior left maxilla

There is a moderately well-defined, non-corticated, mixed radiolucent/radiopaque entity located within the left maxilla, which extends from the distal aspect of tooth 23 to the distal aspect of tooth 27, and from the alveolar crest to the floor of the left maxillary sinus. The posterior-most margin of this lesion may not have been completely captured in this imaging volume. The internal structure of this entity is composed of dense, amorphous bone intermixed with low density granular bone. This lesion has caused distal displacement of the root of tooth 25, and external resorption of the roots of tooth 26. The maxillary sinus floor overlying this lesion appears elevated and thinned, and the buccal and palatal surfaces of the alveolar process appear expanded in an irregular fashion. In spite of this, the sinus floor and contiguous buccal and palatal cortical plates remain intact. After reviewing the follow-up scan dated February 13, 2017 (case ID: 143685), these findings suggest an expansile focus of osseous dysplasia, which does not require treatment.

Axial views of the posterior left maxilla

These axial cross-sectional images demonstrate the presence of a moderately well-defined, non-corticated, mixed radiolucent/radiopaque lesion located within the left maxilla. This entity extends from the distal aspect of tooth 23 to involve the periradicular bone of teeth 26 and 27. The distal-most margin of this entity may not have been completely captured. Note that the internal organization of this entity is composed of dense, amorphous calcifications that are surrounded by low-density granular bone.

Buccolingual views of the posterior left maxilla

These buccolingual cross-sectional images demonstrate that the buccal and palatal surfaces of the posterior left maxilla appear expanded in an irregular fashion. The contiguous buccal and palatal cortical plates appear thinned, but remain intact.

Mesiodistal views of the posterior left maxilla

These mesiodistal cross-sectional images demonstrate that the floor of the left maxillary sinus overlying the mixed radiolucent/radiopaque lesion appears focally elevated. The sinus floor remains intact, despite this finding. Tooth 25 has been severely displaced in a distal direction by this entity, and external resorption is evident in tooth 26.

2. Severe displacement + external resorption in tooth 25

The endodontically-treated tooth 25 has been severely displaced in a distal direction due to its close proximity to the mixed radiolucent/radiopaque lesion. The distal surface of tooth 25 abuts the mesial surface of the mesiobuccal root of tooth 26. External resorption is evident along the distal aspect of the apical half of the root of tooth 25. This tooth is nearly devoid of osseous support.

3. Extensive external resorption in tooth 26

Extensive external resorption is evident in the mesiobuccal root of tooth 26, and the majority of this root appears to have been resorbed. External resorption is also evident along the mesial surface of the apical half of the distobuccal root of this tooth. The resorption abuts the root canal system of this tooth, but there are no radiographic signs of inflammatory disease.

4. Possible detached root tip of tooth 26MB

A small ovoid radiopacity is present in the mesiobuccal aspect of the alveolar process at site 26, which exhibits a density similar to dentin. This radiopacity is surrounded by a periodontal ligament space. This likely reflects a detached and displaced root tip of the severely resorbed mesiobuccal root of tooth 26.

No evidence of root resorption in tooth 27

The abnormal, dysplastic bone pattern associated with the mixed radiolucent/radiopaque lesion has extended distally to involve the periradicular bone associated with tooth 27. In spite of this, there are no radiographic signs of root resorption in this tooth.

4. Mucous retention cyst in left maxillary sinus

A mucous retention cyst is evident within the left maxillary sinus. This a non-significant incidental finding with no clinical significance.