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Troublesome / painful / cracked tooth (Endodontic)
Region of interest
pathology 36/35 tooth area, suspect cyst
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1. Periapical osseous dysplasia associated with tooth 36M
There is a well-defined, spherical radiopacity located apical to the mesial root of tooth 36. This entity is lined by a soft tissue capsule with a relatively uniform width. This bulbous mass exhibits a density that is slightly lower than cortical bone. This entity has caused external resorption of the apical third of the mesial root of tooth 36, and a clear boundary cannot be identified between these structures. This entity has not yet encroached the contiguous buccal and lingual cortical plates. The left inferior alveolar nerve canal is not within close proximity to this radiopacity.
While these radiographic features slightly favor that of a cementoblastoma, a follow-up discussion with the patient's surgeon revealed the existence of other similar foci of amorphous radiopacities located within the edentulous site 48, and also apical to the distal root of tooth 46, which were noted on prior panoramic radiographs that were not made available at the time of the original CBCT interpretation. The multifocal presentation of these entities changes the interpretation to that of periapical osseous dysplasia, which does not require surgical intervention.
2. Secondarily affected tooth 35
The radiopacity associated with the mesial root of tooth 36 abuts the distal aspect of the root apex of tooth 35. However, a radiographically discernible boundary is observed between these structures. There is no evidence of root resorption in tooth 35.