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Referral details

Case 19375

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Referral category

Impacted / delayed / malpositioned / extra teeth

Region of interest

48, 28

Referral reason

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Canaray 19375

Impacted teeth 27 and 28

The eruption of tooth 27 has been impeded by the malformed tooth 28 that is positioned distolingually and slightly coronally to the crown of tooth 27. The root of tooth 27 appears to be developing normally, and no damage is present on teeth 26 and 27. Tooth 28 is slightly malformed as it develops around the crown of tooth 27. Tooth 28 can be surgically accessed from the palatal aspect of the crest of the maxillary alveolar process.

Axial slices of teeth 27 and 28

These axial cross-sectional images demonstrate the absence of damage to the roots of tooth 26, the normal shape of tooth 27, and the distolingually positioned developing tooth 28 coronal to tooth 27.

1. Complex odontome coronal to tooth 48

A complex odontome is forming coronally to tooth 48. This odontome has displaced the mandibular canal inferiorly and has also displaced the developing tooth 48 to the inferior border of the mandibular alveolar process. The radiographic features that support the diagnosis of a complex odontome are the presence of enamel internally, and the well-defined periodontal ligament space surrounding the entity.

Axial views of complex odontome

These axial cross-sectional images demonstrate the presence of enamel in the disorganized internal structure of the complex odontome, as well as the buccolingual expansion of the mandibular alveolar process that the entity has caused.

Right mandibular nerve through mesial and distal furcations of tooth 48

Tooth 48 has four roots. The mandibular nerve passes through the mesial and distal furcations of the roots of tooth 48 and is moderately compressed by the roots of the tooth. The developing roots have extended through the inferior border of the mandibular alveolar process, increasing the risk of jaw fracture during surgery. The crown of tooth 48 is buccally positioned in the mandibular alveolar process.

2. Axial views of mandibular nerve passing through furcations of tooth 48

These axial cross-sectional images demonstrate the passage of the mandibular nerve through the mesial and distal furcations of the roots of tooth 48. Note the convergence of the root apices, which suggests that the mandibular nerve is enveloped by the roots of the tooth.