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Troublesome / painful / cracked tooth (Endodontic)
Region of interest
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1. Possible long-standing radicular cyst at tooth 27
A well-defined unilocular reducing cystic lesion is present within the periapical region of tooth 27. This entity has displaced the sinus floor superiorly. Internally, a second well-defined concentric unilocular cystic entity is visible. Soft tissue or fluid is present on both sides of this internal corticated region. This most likely represents a dystrophic calcification at the surface of the thickened lining of the original larger cystic lesion, and is suggestive of the presence of a longstanding lesion. No unfilled canals are present in tooth 27. No signs of root fracture are present. The periapical lesion will likely require surgical removal.
Orthogonal measurements of lesion in left maxilla
These orthogonal cross-sectional images demonstrate the approximate dimensions of the lesion in the left maxilla.
2. Secondarily affected tooth 26DB
The lesion associated with tooth 27 extends mesially to surround the apical third of the distobuccal root of tooth 26. This lesion extends into the periapical region of the distobuccal root and the tooth may be endodontically compromised. The remaining periradicular bone appears normal. There are no signs of a root fracture.
3. Secondarily affected tooth 28
The lesion associated with tooth 27 extends distally to abut the mesial aspect of the apical third of the root of tooth 28. The remaining periradicular appears normal, which suggests that tooth 28 has been secondarily affected, as opposed to a contributing source of pathology.
Periodontal bone loss
Mild horizontal periodontal bone loss is present on tooth 25. Moderate horizontal periodontal bone loss is present on teeth 26, 27, and 28.
4. Moderate mucositis in left maxillary sinus
Moderate mucositis is present in the left maxillary sinus. The lesion associated with tooth 27 is likely a contributing factor.