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Case 250256

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Troublesome / painful / cracked tooth (Endodontic)

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Canaray 250256

Putative canal postions overlaid on tooth 27

Tooth 27 is a morphologic variant with fused roots. The root canal system is likely complex and may contain many narrow isthmuses and anastamoses. However, the likely positions of the mesiobuccal distobuccal and palatal canals are shown in the accompanying images. The palatal canal has a ribbon accessed. The distobuccal canal appears to converge with the palatal canal at the level of the apical third of the root. The mesiobuccal canal appears to be partially or completely calcified, and it is not possible to radiographically determine whether any canals are present within the isthmus between the mesiobuccal and palatal canals.

1. Rarefying osteitis at tooth 27

These orthogonal cross-sectional images demonstrate the appearance of the root canal system of tooth 27 without any overlays. Periapical rarefying osteitis is present, which has displaced the sinus floor superiorly. The bone surrounding the coronal two thirds of the roots of the tooth appears normal. No signs of root fracture present.

2. Secondarily affected tooth 26DB

The rarefying osteitis associated with tooth 27 extends mesially to abut the distopalatal aspect of the apical third of the distobuccal root of tooth 26. The remaining periapical and periradicular bone appears normal, which suggests that tooth 26 has been secondarily affected, as opposed to a contributing source of pathology.

3. Left antral pseudocyst

A pseudocyst is present within the left maxillary sinus. This represents a non-significant incidental finding.