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Referral details

Case 193654

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Referral category

Impacted / delayed / malpositioned / extra teeth

Region of interest

Cyst in 35 area

Referral reason

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Canaray 193654

1. Benign odontogenic cyst or tumor associated with impacted tooth 35

A well-defined, corticated, unilocular radiolucency is associated with the pericoronal region of the horizontally impacted tooth 35. The contiguous buccal cortical plate is thinned and expanded, and a lamellar periosteal reaction is evident along the buccal surface of the mandibular cortex distal to this pericoronal radiolucency. This pattern of periosteal bone formation suggests a rapid rate of growth of the pericoronal lesion. The left mandibular nerve canal courses inferior to this radiolucent lesion and is mildly deflected. Although this radiolucency abuts the mesial root of tooth 36, no root resorption is noted.

This radiographic appearance is most consistent with a benign odontogenic cyst or cystic tumor. The possibilities of a unicystic ameloblastoma or an asymmetric dentigerous cyst should be considered. Biopsy and histopathologic evaluation is indicated.

No evidence of ankylosis of tooth 35

These cross-sectional images are oriented perpendicular to the long axis of tooth 35. The periodontal ligament space is visible, which suggests this tooth is not ankylosed.

Normal tooth 34

Tooth 34 is unaffected by the impacted tooth 35. The developing root apex of tooth 35 is positioned distolingual to the apical half of the root of tooth 34.

Retained tooth 75

The deciduous tooth 75 is retained within the alveolar process, but exhibits moderate physiologic root resorption. The crown of tooth 35 is located apical and slightly lingual to the residual distal root of tooth 75.

Tooth 36 unaffected by tooth 35

Tooth 36 is unaffected by the impacted tooth 35 or the associated pericoronal radiolucency. The crown of tooth 35 is positioned mesial to the coronal half of the mesial root of tooth 36.

Axial views of mid-3rd quadrant

These axial cross-sectional images demonstrate the apical and slightly lingual position of the crown of tooth 35 relative to the distal root of tooth 75. The pericoronal radiolucency associated with tooth 35 has resulted in buccal expansion and periosteal bone formation adjacent to the residual buccal cortical plate overlying tooth 36. No resorption is noted on teeth 34 and 36 as a result of the impacted tooth 35 or the associated pericoronal radiolucency.

2. Caries on teeth 26 and 36

Caries are noted within the occlusal aspects of the crowns of teeth 26 and 36. No direct pulpal communication is noted at this time.