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Case 172216

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Referral category

Troublesome / painful / cracked tooth (Endodontic)

Region of interest

24

Referral reason

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Canaray 172216

1. Marsupialized mucocele in left maxillary sinus

The majority of the left maxillary sinus is opacified except for the superior aspect, where an aerated area and air-fluid level can be seen. Significant expansion, mainly hydraulic in nature, thinning, and discontinuities are seen along the medial, facial, and posterolateral walls. A trap-door bone defect with elevated borders and associated soft tissue growth is present along the facial surface of the maxillary sinus superior to teeth 24, 25, and 26. This appears to be the site of marsupialization of the entity. The medial wall of the sinus extends medially and almost abuts the nasal septum. Significant root resorption is seen on teeth 23, 24, 25, and 26 which has a sharp-edge pattern. The lesion appears to have originated within the sinus rather than the alveolar bone. The teeth appear to be secondarily infected, rather than the source of the pathology. The most likely diagnosis is a marsupialized mucocele.

2. Moderate right maxillary sinusitis

The right maxillary sinus is partially opacified and air bubble formation is present, which is an appearance consistent with moderate sinusitis.

3. Secondarily affected tooth 26MB: external resorption

External resorption is present on the apical third of the mesiobuccal root of tooth 26. This resorptive defect appears to abut the root canal system of the mesiobuccal root. This external resorption has likely been caused by the lesion in the left maxillary sinus. The remaining periradicular appears normal, which suggests that tooth 26 has been secondarily affected, as opposed to a contributing source of pathology.

4. Secondarily affected tooth 25: external resorption

The apical third of the root of tooth 25 has been completely resorbed. This resorptive defect involves the root canal system of the mesiobuccal root. This external resorption has likely been caused by the lesion in the left maxillary sinus. The remaining periradicular appears normal, which suggests that tooth 25 has been secondarily affected, as opposed to a contributing source of pathology. A partially sequestered tooth fragment is retained within the mucosal thickening of the left maxillary sinus, adjacent to the sinus floor.

5. Secondarily affected tooth 24: external resorption

External resorption is present on the palatal root of tooth 24 and the apical third of the palatal root is almost completely resorbed. This resorption is likely caused by the lesion within the left maxillary sinus. The palatal root of the tooth remains unobturated. There are no signs of periapical or periradicular pathology on tooth 24. The remaining periradicular bone appears normal. There are no signs of a root fracture.

Endodontic sealer has been extruded through the apical foramen of the palatal root and is retained in the mucosal thickening of the left maxillary sinus.

Retained root of tooth 21

The endodontically-treated root of tooth 21 is retained within the alveolar process. There are no signs of periapical or periradicular pathology.

Retained root of tooth 11

The endodontically-treated root of tooth 11 is retained within the alveolar process. The periapical periodontal ligament space on the tooth is widened, which may represent a healed post-treatment appearance with an apical scar or persistent low-grade endodontic pathology. The remaining periradicular bone appears normal. There are no signs of a root fracture.

Impacted tooth 18

Tooth 18 is vertically impacted. There is no evidence of root resorption on the distal surface of tooth 17. The periodontal ligament space is of uniform width surrounding the root of the tooth and the lamina dura is intact. The crown of tooth 18 has partially erupted through the alveolar crest and the residual follicle surrounding the crown of the tooth appears normal. These findings suggest that the tooth is not ankylosed.

6. Caries on tooth 37Bu

A carious lesion is present on the buccal aspect of the crown of tooth 37. This lesion extends in close proximity to, but has not yet encroached the root canal system of the tooth. The periapical region of this tooth cannot be assessed based on this limited field of view.

Impacted tooth 38

Tooth 38 is horizontally impacted. There is no evidence of root resorption on the distal surface of tooth 37. The left inferior alveolar nerve canal passes inferior to the tooth and is not compressed. The periodontal ligament space is of uniform width surrounding the root of the tooth and the lamina dura is intact. The crown of the tooth has partially erupted through the alveolar crest and the residual follicle surrounding the crown of the tooth appears normal. These findings suggest that the tooth is not ankylosed.

7. Sphenoid sinus mucositis

The posterior half of the left loculation of the sphenoid sinus appears opacified. This may represent mucositis of the sphenoid sinus, and is a nonsignificant incidental finding

8. Calcified stylohyoid ligament

The right stylohyoid ligament is partially calcified. This is an incidental finding with no clinical significance.