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Case 197454

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Referral category

Disease / syndrome / tumor / condition

Region of interest

Anterior posterior Mandible

Referral reason

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Canaray 197454

1. Lesion has increased in size since prior scan

The current scan (shown in redscale) was overlaid on the prior scan (Canaray Case 178566, dated 16 November 2017, shown in grayscale). In the interval, the lesion has increased in size, as shown by the increased dimensions of the red bone boundaries. The lesion exhibits progressive growth.

Benign odontogenic cyst tumor or neoplastic lesion in anterior mandible: present study

A well-defined, unilocular, delicately-corticated cystic entity is centered in the interradicular region of teeth 31 and 32, which extends from the alveolar crest to the inferior border of the mandible, and from the root apex of tooth 43 to the root apex of tooth 34. The contiguous buccal and lingual cortical plates are expanded and thinned, and may be partially dehiscent. There is a significant buccolingual expansion of the alveolar process. Apical resorption is evident on the involved teeth, and the roots of teeth 31 and 32 are splayed as a result of extension of this cystic lesion into the interradicular area of these teeth. The remaining buccal cortical plate appears slightly granular, which supports the purported histopathologic diagnosis of giant cell lesion.

Orthogonal measurements of the lesion

These orthogonal cross-sectional images demonstrate the approximate mesiodistal, buccolingual, and coronoapical dimensions of the lesion in the anterior mandible.

2. Displaced and resorbed tooth 41

The radiolucency abuts the mesial surface of the apical half of the root of tooth 41. The root of the tooth is distally displaced. Apical root resorption is evident.

3. Apical resorption on tooth 42

Due to its close proximity to the radiolucent lesion, resorption is observed along the mesial aspect of the apical third of the root of tooth 42. There is no significant evidence of tooth displacement.

4. Secondarily affected tooth 43: no resorption

The lesion in the anterior mandible extends onto the mesial surface of the root apex of tooth 43. The remaining periradicular bone appears normal. No resorption is evident on the root of tooth 43. Clinical vitality testing of this tooth is necessary to substantiate this interpretation.

5. Displaced and resorbed tooth 31

The radiolucency abuts the distal and apical surfaces of the root of tooth 31. Apical root resorption is evident. The tooth is significantly mesially displaced.

6. Displaced and resorbed tooth 32

The radiolucency abuts the mesial and apical surfaces of the the root of tooth 32. Apical root resorption is evident. The tooth is significantly distally displaced.

7. Apical resorption on tooth 33

Due to its close proximity to the radiolucent lesion, resorption is observed along the mesial aspect of the apical third of the root of tooth 33. There is no significant evidence of tooth displacement.

8. Secondarily affected tooth 34: no resorption

The lesion in the anterior mandible extends onto the root apex of tooth 34. The remaining periradicular bone appears normal. No resorption is evident on the root of tooth 34. Clinical vitality testing of this tooth is necessary to substantiate this interpretation.

9. Malformed tooth 22: Dens in dente + patent apex

An enamel lined cavity extends apically from the cingulum of tooth 22 through the crown of the tooth, which extends along the mesial surface of the root to the midroot level. This is representative of dens in dente. The mesiodistal width of the tooth has increased. The root canal of tooth 21 exhibits enlargement and the root apex is open and has not been formed. Remnant of dental papilla is present. This appearance is in concordance with the dental findings associated with dense in dente in the mesial aspect of the tooth. No periapical pathology is associated with tooth 21 at this time.