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Referral details

Case 131971

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Referral category

Troublesome / painful / cracked tooth (Endodontic)

Region of interest

16

Referral reason

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1 Files Info

Canaray 131971

1. Rarefying osteitis in O-shaped tooth 16

Tooth 16 is a rare anatomic variant with mesiobuccal, distobuccal, mesiopalatal, and distopalatal roots that are all fused with one another, resulting in an O-shaped root canal system. There is rarefying osteitis located periapical to the mesiobuccal, distobuccal, mesiopalatal, and distopalatal root apices of this tooth, which indicates persistent endodontic pathology. The existing obturations in the distobuccal and distopalatal canals of this tooth extend to their radiographic apices. The endodontic access of the mesiobuccal canal of this tooth is mesially positioned and appears within close proximity to its mesiobuccal root surface. However, given the absence of signs of periradicular pathology, root perforation is likely not present. The remainder of the mesiobuccal canal appears unfilled. As well, the isthmus regions joining the mesiobuccal, distobuccal, mesiopalatal, and distopalatal canals of this tooth are also unfilled. Given the complexity of its root canal system, extraction or intentional reimplantation of this tooth may be considered.

Axial views of tooth 16

These axial cross-sectional images demonstrate that tooth 16 is a rare anatomic variant whereby its mesiobuccal, distobuccal, mesiopalatal, and distopalatal roots are all fused with one another, resulting in an O-shaped root canal system in axial cross-section. The attempted endodontic access of the mesiobuccal canal of this tooth is mesially positioned, and appears within close proximity to its mesiobuccal root surface. However, there are no signs of periradicular pathology adjacent to this region, which suggests that a root perforation is likely not present. The obturations of the distobuccal and distopalatal canals of this tooth extend to their radiographic apices. However, the isthmus regions joining the primary canals of this O-shaped tooth remain unfilled and appear heavily calcified.

Buccolingual views of tooth 16

These buccolingual cross-sectional images demonstrate that the buccal cortex overlying the periapical region of tooth 16 appears thinned and may be partially dehiscent. The contiguous palatal cortical plate appears intact.

Mesiodistal views of tooth 16

These mesiodistal cross-sectional images demonstrate the periapical epicenter of rarefying osteitis associated with the mesiobuccal, distobuccal, mesiopalatal, and distopalatal roots of tooth 16. The floor of the maxillary sinus overlying these regions appears elevated and thinned. The remaining periradicular bone located mesial and distal to this tooth appears normal, and there are no radiographic signs of a displaced root fracture.

2. Mild mucositis of right maxillary sinus

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