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Case 188214

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Referral category

Impacted / delayed / malpositioned / extra teeth

Region of interest

UL

Referral reason

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Canaray 188214

1. Large unilocular cystic lesion in anterior second quadrant

A well defined unilocular radiolucent cystic lesion is present in the anterior second quadrant. This entity has a corticated periphery. Internally, the lesion is predominantly radiolucent, but multiple tiny radiopacities are visible near the periphery, particularly at the superior, buccal and posterior aspects of the lesion. Teeth 22 and 23 have been superiorly, buccally and posteriorly displaced by this lesion, and are impacted. The roots of the deciduous teeth adjacent to the entity exhibit physiologic resorption. Teeth 21 and 24 have been displaced, but do not exhibit any resorption or damage. The presence of radiopacities within the entity may represent dystrophic calcifications in a long-standing lesion or intrinsic calcifications that are characteristic of the lesion. The differential diagnosis includes a long-standing dentigerous cyst associated with tooth 22 or a cystic tumor, such as an adenomatoid odontogenic tumor or a calcifying cystic odontogenic tumor.

Orthogonal measurements of the cystic lesion in the anterior left maxilla

These orthogonal cross-sectional images demonstrate the approximate mesiodistal, buccolingual, and coronoapical dimensions of the cystic entity in the anterior left maxilla.

2. Secondarily affected + displaced tooth 21

The cystic lesion in the anterior left maxilla extends mesially to abut the distal surface of the apical two thirds and periapical region of the root of tooth 21. The remaining periradicular bone surrounding tooth 21 appears normal. This pattern of bone loss suggests that tooth 21 has been secondarily affected as opposed to a contributory source of pathology. There is no evidence of root resorption, but the root apex of tooth 21 appears mesially displaced.

Moderate physiologic resorption of tooth 62

Tooth 62 exhibits moderate physiologic root resorption in the region adjacent to the cystic lesion. The tooth is nearly devoid of osseous support.

Impacted and displaced tooth 22

The large unilocular cystic lesion in the anterior second quadrant appears to be associated with the coronal half of tooth 22. The lesion has displaced tooth 22 superiorly and posteriorly. Root formation of tooth 22 is complete. No signs of malformation or damage are radiographically evident. However, the root apex of the tooth exhibits a small apical curve. It is possible that the cystic lesion is a large dentigerous cyst associated with this tooth.

Moderate physiologic resorption of tooth 63

Tooth 63 exhibits moderate physiologic root resorption in the region adjacent to the cystic lesion. The tooth is nearly devoid of osseous support.

Impacted, displaced, + rotated tooth 23

Tooth 23 has been distally and superiorly displaced by the cystic lesion in the anterior second quadrant. The development of tooth 23 is complete. No signs or malformation or damage are present. The follicle surrounding the crown of tooth 23 is distinct from the cystic lesion that is positioned anteriorly to the tooth.

3. Secondarily affected + displaced tooth 24

The cystic lesion in the anterior left maxilla extends distally to abut the mesial surface of the apical two thirds and periapical region of the roots of tooth 24. The remaining periradicular bone appears normal. This pattern of bone loss suggests that tooth 24 has been secondarily affected as opposed to a contributory cause of pathology. There is no evidence of root resorption, but the roots of tooth 24 are displaced in a distopalatal direction.

4. Secondarily affected tooth 25

The mesial surface of the apical third of the developing root of tooth 25 has been secondarily affected by the cystic entity in the anterior left maxilla. The remaining periapical and periradicular bone appears normal, which suggests that tooth 25 is not the source of pathology. No resorption is present at tooth 25.

5. Mild mucositis of left maxillary sinus

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

Sagittal views of left maxillary sinus

These sagittal cross-sectional images demonstrate the mild mucositis that is present in the left maxillary sinus. The root of tooth 23 is positioned along the sinus floor.