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Case 183643

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Referral category

Dental implants

Region of interest

27

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Canaray 183643

1. Concrescence between tooth 27 and partially resected tooth 28

A conically shaped radiopacity is observed just apical and distal to tooth 27, which exhibits a density comparable to dentin and cementum, and contains a root canal system. The crestal surface of this radiopacity appears irregularly shaped, and a crown cannot be identified. These findings suggest the presence of a retained root fragment, following partial resection of a previously impacted tooth 28. Correlation with previous dental radiographs may aid in substantiating this interpretation. The roots of tooth 27 exhibits excessive cementum formation, which is consistent with hypercementosis. This hypercementosis appears fused with the hypercementosis around the retained root fragment of tooth 28, which is suggestive of concrescence. This will complicate the extraction of this retained root fragment.

2. Rarefying osteitis around retained root fragment of tooth 28

There is rarefying osteitis located around the retained root of tooth 28. The contiguous sinus floor appears elevated and sclerotic, which is suggestive of chronic inflammation. This bone loss appears to be draining through a dehiscence in the alveolar crest.

3. Radicular defect on tooth 27P

An irregularly shaped defect is observed along the furcal surface of the palatal root of tooth 27, which encroaches its palatal root canal system. This may be post-surgical in origin or secondary to external resorption.

4. Slightly widened PDL space on tooth 25

There is a slight widening of the periodontal ligament space around the root apex of the endodontically-treated tooth 25. The existing obturations of the buccal and palatal canals of this tooth extend to their radiographic apices. These findings could suggest the presence of persistent low-grade endodontic pathology or fibrous scar tissue, and interval radiographic comparisons are needed to make this distinction.

Hypercementosis in multiple teeth

Teeth 23, 24, 25, 26, and 27 exhibit excessive cementum formation, which is consistent with hypercementosis.

5. Moderate mucosal thickening in left maxillary sinus

Moderate mucosal thickening is evident in the left maxillary sinus, which exhibits a polypoid contour. This could represent mucositis secondary to dental inflammatory disease. Clinical correlation is recommended to rule out the possibility of sinusitis.

Sagittal views of the left maxillary sinus

These sagittal cross-sectional images demonstrate the presence of moderate mucosal thickening along the floor of the left maxillary sinus, which may impede a sinus lift procedure. Note the elevation of the sinus floor apical to site 28, which indicates chronic inflammation.