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Case 191165

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Referral category

Wisdom Teeth

Region of interest

Top right sinus appears to have a cyst displacing the 18

Referral reason

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Canaray 191165

1. Benign odontogenic cyst or tumor associated with impacted tooth 18

Tooth 18 is horizontally impacted and is displaced mesially by a pericoronal radiolucency. The floor of the right maxillary sinus is elevated to the orbital floor, and the posterolateral sinus wall is expanded, thinned, and dehiscent. The alveolar crest is lost at site 18.

This radiographic appearance reflects the presence of a benign odontogenic cyst or cystic neoplasm associated with the pericoronal region of the impacted tooth 18. The possibility of a dentigerous cyst or a unicystic ameloblastoma should be considered. A biopsy and histopathologic evaluation is indicated for a definitive diagnosis.

2. Maxillary sinus mucositis

Mucositis is present in the residual air space of the right maxillary sinus.

Additional views of tooth 18

These images demonstrate the horizontal orientation of the impacted tooth 18. The crown of tooth 18 is positioned apical to site 17, and the root apices of tooth 18 are positioned apical to site 16.

Axial views of right maxilla

These axial cross-sectional images demonstrate extensive expansion and thinning of the posterolateral wall of the right maxillary sinus. The possibility of soft tissue lesional extension should be considered. The medial and anterolateral sinus remain intact.

Mesiodistal views of right posterior maxilla

These mesiodistal cross-sectional images demonstrate the mesial displacement of the impacted tooth 18 into the right maxillary sinus. The sinus floor is elevated to the level of the orbital floor. The alveolar crest is lost at site 18. Recent extraction sockets are evident at sites 16 and 17.

Buccolingual views of right posterior maxilla

These buccolingual cross-sectional images demonstrate mucositis within the residual antral air space of the right maxillary sinus. Note that the medial sinus wall remains intact.

3. Recent extraction sockets at sites 16 and 17

The right maxilla exhibits recent extraction sockets at sites 16 and 17. No reparative bone is present at this time. The sinus floor remains intact apical to sites 16 and 17.

Periodontal bone loss in left posterior maxilla

Mild horizontal periodontal bone loss is present on the left maxillary premolars. Severe periodontal bone loss is noted on tooth 26.

4. Periodontal bone loss + calculus on tooth 26P

The palatal root of tooth 26 exhibits severe periodontal bone loss and calculus deposition. The contiguous palatal cortical plate is lost. The possibility of secondary endodontic involvement should be considered.

5. Periradicular bone loss + widened PDL space on tooth 48

Vertical periodontal bone loss is present on the buccal and lingual aspects of tooth 48, and apical periodontal ligament space widening is noted. The vitality of tooth 48 should be assessed.

6. Mild mucositis in the left maxillary sinus

Mild mucositis is present within the left maxillary sinus. This level of mucosal thickening is a non-significant incidental finding.

7. Right palatine tonsillolith

A tonsillolith is present in the right palatine tonsil. This is an incidental finding with no significance.