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Troublesome / painful / cracked tooth (Endodontic)
Region of interest
Posterior 2nd quadrant
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1. Possible mucocele in left maxillary sinus: ENT referral recommended
The portion of the left maxillary sinus that is visible in the field of view is completely opacified. The anterior wall of the sinus exhibits a prominent zone of expansion. The sinus floor is positioned in close proximity to the root apices of teeth 25, 26, 27. The periapical region originating at tooth 27 is not continuous with the sinus floor. The overall radiographic appearance is suggestive of the presence of a sinus mucocele, rather than an endodontic lesion. However, the incomplete capture of the sinus in this scan prevents a definitive diagnosis from being made. Further investigation of the sinus by an ENT specialist is highly recommended.
2. Extruded sealer at tooth 25
A small amount of extruded endodontic sealer is present in the periapical region of tooth 25. No bone separates the root apex of tooth 25 from the sinus mucocele. However, the recent nature of the endodontic treatment of tooth 25 suggests that this tooth is not the source of the large pathologic lesion in the posterior maxilla. Tooth 25 does not exhibit any unfilled canals or signs of fracture.
3. Unobturated apical segment of tooth 26P
The apical third of the palatal root of tooth 26 remains unobturated. No bone is visible on the sinus floor adjacent to the palatal root apex of the tooth, and it is possible that tooth 26 is a contradictory factor to the lesion within the left maxillary sinus. However, in the absence of a complete review of the sinus, this is a not definitive finding. It is not possible to radiographically determine whether the obturation of tooth 26 is failing or not.
4. Rarefying osteitis at tooth 27
Rarefying osteitis is present in the periapical region of tooth 27. This rarefying osteitis extends through the buccal cortical plate adjacent to the mesiobuccal root and also drains to the alveolar crest in the furcal regions of the tooth. This radiographic appearance is suggestive of a failing endodontic obturation of tooth 27. The periapical lesion originating at tooth 27 does not appear to be the source of the lesion within the left maxillary sinus.